National Organizations Take on Childhood Obesity

While access to healthcare tops most pediatrician's list of legislative priorities, reversing the trend of overweight children is quickly climbing to the top of clinical concerns. Dr. Bob Holmberg, a board certified pediatrician for Eastern Maine Medical Center's Norumbega Pediatrics group, sits on the American Academy of Pediatrics Obesity Task Force, which was created two years ago. "It is increasingly recognized that the acceleration of the prevalence of obesity is one of the major epidemics we're dealing with," Holmberg said. He added the task force is focused on developing practical, evidenced-based guidelines for what pediatricians can do to combat the problem in their offices. A second, equally important mandate is to find a way to collaborate and coordinate with other groups from urban planners to school lunch directors to fast food providers on what is clearly a multifactorial problem. Boiled down to the basics, healthcare providers and communities as a whole must find a way to reduce empty calories, decrease huge portion sizes and increase physical activity. What sounds relatively simple, however, isn't. Holmberg shared a variety of alarming statistics including: o The rate of obesity has doubled over the last 20 years in children of all ages and has tripled in the teenage population. o Fifteen percent of children are felt to be overweight which equates with a BMI that puts them over the 95th percentile. o A recent Maine study found as many as 36 percent, or more than one-third, of the children entering kindergarten were either at risk or overweight as defined by a BMI over the 85th percentile. o Sixty percent of overweight children currently have at least one other risk factor for chronic heart disease or diabetes and 20 percent of these children have two or more risk factors. "It's got to be more than genetics to see that rapid change," Holmberg said of the nation's increasing problem with obesity. "The genes haven't changed that much, but our society has." Holmberg noted that "screen time," most notably watching television or playing video games, is one of the big changes in society over the last generation and is a key culprit in weight gain. "There's good science behind the number of hours of TV correlating with adiposity," he said, adding that average television viewing time for children ages five-18 ranges from three to seven hours a day. He added that studies have shown that a television in the bedroom adds an additional one-to-two hours of viewing time per day. "Get the TV out of the bedroom," he stated … better still, he added, "Turn off the TV and get kids outside." Because weight is such a touchy subject and one that is hard for many physicians to broach, Holmberg said there is an increasing emphasis on achieving a healthy weight for a child's height and bone structure and stressing healthy, active lifestyles rather than lecturing on the dangers of being overweight. Motivational interviewing — searching out a patient's personal goals — is one technique that is being increasingly used with good results. In Holmberg's home state, the Maine Youth Overweight Collaborative has brought together pediatricians and allied public health officials to try to stem the rising tide of overweight children. One approach the group has taken is the 5210 concept: o 5 fruits and vegetables a day, no more than 2 hours of screen time a day, o 1 hour or more of physical activity and essentially 0 sodas. Holmberg noted there are multiple barriers that must be overcome to achieve a healthier lifestyle … many of these problems are societal in nature. "One problem is not only increased inactivity but decreased activity," he said. In Maine, 95 percent of high school students do no get daily PE classes — a statistic that is played out in many states across the country. Nationally, 25 percent of all trips a family takes are less than one mile, but 75 percent of those are by car. Portion sizes are another big problem facing America. Holmberg pointed out the average soda was 12 ounces just a few years ago. Today the average is a 20-ounce drink. "A 100-pound child that has just drunk a 20 ounce soda needs to bike one hour and 15 minutes to burn off that soda," he said. "Imagine if that child's just had a big Happy Meal … it would be almost a marathon to burn that off." Burning off calories doesn't have to be formal such as time at the gym … as a matter of fact, it probably shouldn't be for children. "We're just encouraging getting kids outside for safe, natural play," Holmberg said. He added for overweight children, walking and swimming are two of the most effective tools. Because of the important place physicians have in the development of their young patients, Holmberg said the Obesity Task Force is finding doctors really need to play three key roles in combating the obesity epidemic. First is addressing the medical considerations of obesity and its byproducts. Second is having sane interventions that really hark back not to medical interventions but rather to behavioral changes. Finally, physicians should be focusing on preventative measures by addressing healthy lifestyle issues with every child and their family no matter what the patient's BMI. Developing a "sane intervention" was the impetus behind the newly announced "WE CAN" campaign that was launched last month as a collaborative effort between the Department of Health and Human Services, the National Institutes of Health and community partners across the nation. WE CAN — Ways to Enhance Children's Activity and Nutrition — is a science-based program aimed at teaching children and parents to choose smaller portions, eat healthier foods, substitute water or fat-free or low-fat milk for sugary sodas and juices, reduce recreational screen time, and engage in moderate physical activity most, if not all, days of the week. In the June 1 issue of the journal Pediatrics a study was published outlining the positive impact lifestyle education can make on a child's health. Results from the ancillary research of the Dietary Intervention Study in Children (DISC) sponsored by the National Heart, Lung and Blood Institute found children ages eight-10 enrolled in a behaviorally-oriented nutrition education program reported switching from high-calorie, high-fat foods to more nutritionally balanced diets. Furthermore, after three years, the children in the intervention group "consumed more than 67 percent of their total calories on average from heart-healthy foods, compared to less than 57 percent for children in the usual care group," according to a release by the NHLBI. Building on this effective model, WE CAN hopes to use behavioral changes and education to turn around the nation's obesity epidemic. "We feel it's very important to try to take steps not only to combat the consequences they'll face as children but ultimate consequences they'll face as adults," Karen Donato, MSRD, coordinator of the NHLBI Obesity Education Initiative, said of this new program. Like Holmberg, Donato pointed out many societal changes over the past 20 years have compounded the nation's problem with weight gain. "People have lost sight of what a normal portion is," she noted. "From studies, we know that if you put larger portions in front of children over the age of five, they're apt to eat more food." Another change from the 1970s to the mid-90s is the number of meals eaten at restaurants or snack bars where portion sizes tend to be large. Donato said during that time period, the intake of foods away from home jumped from 25 percent to 45 percent. Consumption of pizza is up about 400 percent; snacks are up about 300 percent. Conversely, she noted, milk consumption has dropped approximately 30 percent and eating vegetables is down about 40 percent. "We think WE CAN can make a difference because it's a program that's really hoping to harness the power of parents," Donato said of this new effort. The program also hopes to harness the considerable power of physicians and other healthcare providers. "We have as a partner the American Academy of Family Practice," Donato said. "It's critical for physicians and hospitals to get involved and support this." Hospitals and practices are encouraged to use the free program as a teaching module in their community education offerings.