Obesity: A Big Problem
By Jennifer Cheng, MD and Dennis Clements, MD, PhD
is becoming a super-sized nation: everything from meals
to clothing can now be found in ever-increasing sizes. Currently
two out of three American adults and one of three American children
and adolescents are obese or overweightand rates are likely
to continue to rise if current trends continue.
the exact causes of the obesity epidemic have yet to be determined,
its likely the culprit is a combination of genetic and environmental
factors, including a trend towards lower physical activity levels
and poor eating habits.
We live in an environment that, while offering innumerable modern
conveniences, is vastly different from that for which the human
body was designed. Our bodies sophisticated mechanisms to
conserve energy in a time of limited resources betray us in an era
of relative bounty and energy surplus.
environmental factors compound the problem--urban sprawl that requires
people to drive instead of walk; unsafe neighborhoods that discourage
outdoor play; lack of recreational opportunities; and, in some locales,
poor availability of healthful foods.
factors are also important. For instance, while vending machines
in school often dispense junk food, their proceeds can provide a
substantial source of revenue to support important student services
in many financially-strapped school districts.
a separate front, the Presidents No Child Left Behind
policy has resulted in an increased emphasis on academic performance,
sometimes to the detriment of other non-essential programs
such as physical education.
combination of easily available, high-calorie food and fewer opportunities
to exercise makes it easier for children to gain weight. Thats
because maintaining a constant weight requires that the amount of
energy in the food consumed be equivalent to the amount of energy
spent through physical activity. Regularly eating an excess of 100-150
calories per day (the equivalent of a small cookie), for example,
can result in a 10- to 15-pound weight gain over the course of a
year if those calories are not burned up through physical activity.
Two extra cookies per day could potentially result in a 20- to 30-pound
weight gain over a year!
can families do to help children lead healthier lives?
Parents and other family members can play an important role in ensuring
that children adopt and maintain healthful lifestyles despite the
many obstacles present in their environment. Below are some recommendations:
Pregnancy: Women who are pregnant should eat a sensible diet and
avoid smoking and drinking alcohol. In addition, they should take
a prenatal vitamin to ensure adequate nutrient levels, and see their
doctors on a regular basis.
Infants: Breast milk is uniquely tailored to meet all of the babys
nutritional needs for the first six months of life. In addition,
breastfeeding confers many health benefits, including lower rates
of asthma, allergies, ear infections, intestinal problems, diabetes,
and obesity. The American Academy of Pediatrics encourages mothers
to exclusively breastfeed for the first six months (about the time
the babys diet begins to include solid foods), and to continue
breastfeeding for at least 12 months or as long as baby and mother
want to continue.
Children and adolescents: American kids and youth are bombarded
with television advertising. Over 50 percent of television ads are
for processed foods, most of which are high in saturated fat and
simple sugars but low in fiber and protein. Families should discuss
advertising tactics, and teach their children to be educated, health-conscious
Other dietary recommendations include:
Eat breakfast every day! Studies have shown that kids who eat breakfast
do better in school, are less likely to make poor lunch choices,
and less likely to be overweight. Regularly eating meals at home
with the family has also been shown to be associated with similar
Eat out less frequently. For the most part, meals eaten away from
home tend to be higher in fat and calories. However, healthier choices
are generally available even at fast-food restaurants.
Provide plenty of fruits and vegetables (aim for at least five servings
per day) to promote your familys intake of fiber and vitamins.
Main dishes should emphasize complex carbohydrates (such as brown
rice, beans, whole grains, and pasta).
Trim all fat from meat before cooking.
Use cooking methods that require little or no fat, such as broiling,
steaming, and roasting.
Limit sweetened beverages; encourage plain water instead.
Plan snacks ahead of time to ensure that they are nutritious. Do
not spoil your childs appetite by offering snacks too close
Discourage snacking while watching television, which can lead to
a habit of overeating.
Know what is being served to children away from home (at school,
grand-parents, neighbors home, etc.); voice your concern
if the food is not nutritious.
Consider bringing food from home if food choices do not meet nutritional
Understand and monitor serving sizes.
Do not use food as a reward or punishment.
By most accounts, American children are less active today than they
were 20 years ago. One study has found that fewer than 25 percent
of children in grades four through 12 participate in 20 minutes
of vigorous activity or 30 minutes of any physical activity every
day. Experts recommend that children get at least 60 minutes of
physical activity each day for optimal health; adults should aim
for at least 30 minutes of strenuous activity on most days of the
tips for becoming more active include:
a role model. Children are more likely to adopt and maintain active
lifestyles if they see that their parents are active and enjoying
Limit sedentary activities. Studies show that kids who spend more
than two hours a day watching television are more likely to be obese.
The American Academy of Pediatrics recommends that kids spend no
more than one to two hours a day watching TV or playing computer
or video games. (Only non-violent games should be chosen).
Walk more. If possible, bike or walk to school or to the store;
take the stairs instead of the elevator.
Help your child find physical activities that he or she enjoys and
that arent too difficult.
Offer activities, not food, as rewards. For example, go bowling
for a treat rather than staying home to make double hot-fudge sundaes.
On weekends, opt for active family outings such as hiking, swimming,
or mall-walking rather than going to the movies and eating buttered
Push your local school board to make physical education a priority.
Also push for nutritious school lunches and healthy choices in vending
Finally, make sure that your child is getting enough rest and sleep.
Hopefully, these tips will help you develop and foster an environment
that will lead to healthier lives for you and your family.
American Academy of Pediatrics: Guide to Your Childs Nutrition.
Editors: William H. Dietz, MD, PhD and Lorraine Stern, MD. 1999.
Jennifer Cheng, MD, is an assistant clinical professor of pediatrics
at Duke whose research interests include pediatric nutrition and
obesity. Dennis Clements, MD, PhD, is the chief medical officer
of Duke Children's Hospital. For more information, visit: www.dukehealth.org