Double cheeseburger + Nintendo + Pepsi Cola + a couch = Unhealthy Kids
by Joe Tarr
The numbers have been adding up lately. It used to be that each month Children's Hospital would see one or two children recently diagnosed with diabetes.
But in January, there were six, in February, 14, and in March a staggering 27 children referred to the hospital for treatment of the disease, says Cathy Van Ostrand, a clinical nurse specialist in endocrinology at the hospital.
Many of the cases are simply traced to genetics, and there is no real explanation for the rise. But some children are coming down with diabetes because of another alarming trend—they're fat.
It's a pattern that reflects a national one, and it could have far-reaching health, economic and social implications for the country. There's a great deal of attention given to healthy eating, but Van Ostrand doesn't see the obesity trend waning any time soon.
"With obesity, we're seeing it in 2-year-olds," she says. "I can walk down the street and see children and say, 'There's one of my future patients, I'll be seeing you in a couple of years.'"
It may be tempting to shake your head and blame the problem on horrible parents or good-for-nothing kids. But the problem runs much deeper than that.
We want to drive everywhere and have convenient parking; we spend our time watching movies, TV, spectator sports, playing video games and surfing the Internet—yet we wonder why kids are so lazy. We don't have time to cook a decent meal, we devour too much junk food and then wonder why kids are getting heavy. We don't give schools adequate funding, and we make up some of the difference with Twinkies and Cokes sold to students out of vending machines.
"We as a society are not prone to changing our lifestyles. Some of the fast food places are offering healthier items, but nobody's choosing them. We're getting the double quarter-pound cheeseburger with fries and a large chocolate shake," says Van Ostrand, stopping to shake the nearly empty soft drink cup next to her. "That's what I got on my way to work this morning."
In a sense, kids are what our society eats and how it lives.
Kicking the Crunch Berry
Juliann Chavez is standing in front of three boxes of cereal—Capt. Crunch Berry, Cheerios, and Shredded Wheat. "There are no bad foods, but some are better than others," she tells to the class of five.
There's a woman with her 7- and 8-year-old daughters. Both girls have a bit of baby fat on them, but they're not unusually plump. Another woman is here with her 13-year-old boy who looks like he'd easily tip the scales at well over 200 pounds. Even if he weren't overweight he'd still be a big kid—the kind of person people call "big-boned"—and might have a promising future as an offensive lineman.
Chavez, a clinical nutrition specialist for the hospital, asks the kids which of the three cereals is the healthiest for them to eat. "Cheerios" one of the girls offers. Chavez then has them all compare the serving size, calorie, sugar and fiber content listed on each box. She explains that the more fiber and the less sugar the better. And on these counts, Shredded Wheat wins out.
"Now what if you're trying to get yourself off the Crunch?" Chavez says. "Let's say Crunch Berry is your favorite thing in the world, and you're the biggest grouch if you don't have it in the morning. The thing to do is mix them. That way you get more fiber."
Overweight and obese are adjectives defined by the Centers for Disease Control, and the easiest (although not the best) way to determine whether someone falls into these categories is by using the Body Mass Index, or BMI, a height-weight ratio. It's calculated by dividing your weight by your height squared. (For instance, someone 5-foot-9 weighing 150 pounds has a BMI of 22.1. You can quickly calculate your own BMI here.)
The resulting number correlates to body fat, and the higher the number the more at risk you are for illness, heart disease, high blood pressure, diabetes and other problems. In adults, a BMI of 25 to 30 is considered overweight, 30 and above is considered obese.
This formula is not precise—an athletic person might be in the overweight category but simply have a large muscle mass, not excess fat.
For children, the BMI index is age specific, as explained on the CDC's website.
Dieting for children is much trickier and more dangerous than it is for adults, Chavez says. A doctor should be consulted before any child tries to lose weight.
"Weight loss for a child is not the same as weight loss for an adult," Chavez says. "If a child isn't getting enough calories during those years, they could have stunting."
If a child needs to lose weight, he or she needs to lose it slowly. It's also important for children to get a wide variety of foods. Or as she tells the kids, "the more color on your plate—and I'm not talking about yellow mustard and red ketchup—the healthier it is." Which means specialized diets like Atkins—low-carb, high-fat and high-protein—could have bad consequences for kids, who need to have a healthy dose of minerals, vitamins and calories that carbohydrates provide.
Between the 1960s and 1980, the number of overweight children in the United States stayed fairly even at 4 percent, according the Centers for Disease Control. Starting in the mid-'70s, their numbers started to swell. It was noticed first in young children and then, in the '80s, in adolescents. Today 15 percent of children 6 to 19 are overweight, and another 15 percent are at risk of being so. (The CDC doesn't have an "obese" category for children.)
In Tennessee, the numbers are worse. Twenty percent of children are overweight and more than 12 percent of infants and children are at risk.
Locally, no one knows what the stats are. "We really have no idea," says Carolyn Perry-Burst, nutritionist with the Knox County Health Department. "We suspect it is following the national trend."
The University of Tennessee conducted a pilot program at Austin-East High School this spring. It was a voluntary program with about half the students participating. Of those, 42 percent were overweight or at risk. Gene Fitzhugh, the health department's statistics cruncher, doesn't think that's a representative sample. The county plans to take more thorough sample in schools this fall to get a better idea, he says.
There's a slightly better measurement with adults, based on a phone survey—55 percent of adults 18 and up are either overweight or obese. That's just under the national average of 58.8 percent, Fitzhugh says.
Adult Problems
The increase in overweight kids means doctors are seeing more and more kids with ailments thought to be adult, like high blood pressure, high cholesterol and diabetes.
"We have several kids in their teen years who have kidney problems. They're on high-blood-pressure medication and they still don't do what they need to do to take care of themselves. They've never done anything to take care of their diabetes," Van Ostrand says.
There are two types of diabetes. Type 1 is genetic and is diagnosed in children. Type 2 has a genetic component, but it's usually triggered by lifestyle, namely inactivity and excessive weight. People don't usually come down with type 2 until they're 40 or older; often they have it for 10 years before it's diagnosed. But in recent years it's becoming more common in children, even some pre-teens.
Diabetes can sometimes be difficult to recognize, because many of the signs are indicative of growing up or being an adolescent, Van Ostrand says. Excessive hunger, urination, thirst, fatigue and weight loss are some symptoms.
"A lot of times kids who didn't like to drink water are suddenly drinking it all the time. That's what usually makes parents stand up and take notice," she says.
The disease is treatable, but not curable. If unchecked it can cause blindness, kidney disease, heart attack, stroke, and nerve damage, the latter of which can necessitate amputation.
In Knox County, the death rate from diabetes is on the climb, from 17 per 100,000 people in 1990 to 25.9 in 2000. Overall, 7.1 percent of Knox County has the disease. The health department estimates it cost $210 million to treat the disease here last year.
The increase will have other effects, Perry-Burst says. "That's going to dramatically effect productivity. If they get diabetes at age 11—that's a difficult time to be burdened by that disease," she says.
Go Eat
It seems to Georgia Kelley that kids aren't what they used to be. She doesn't mean it the way your neighborhood curmudgeon would—that they're rotten to the core or lacking in talent, ambition, smarts or gumption. Kelley thinks the world of kids, especially the ones at the Powell United Methodist Church's daycare center, where she has worked for 20 years.
But there is one area where today's kids don't seem as quick on the uptake as children did 10 or 15 years ago.
"Not all children know how to play anymore. Years ago, you just went out and played," Kelley says. "[Now] they don't know how to use their imagination. They want to be told what to do. I remember the boys who are now in college would go up on the hill and build a fort. You don't see that as much now. That's because they're used to being told what to do."
Laura Boring, physical education, health and wellness supervisor for Knox County schools, has noticed the same change. "In the old days, your mother chased you out the door and you entertained yourself. Kids today, they expect us to entertain them," Boring says. "At recess kids used to organize their own games like kickball and tag. Nowadays we have really expensive playground equipment. And that's great. But I'm not sure we teach them how to play independently anymore."
The lack of physical activity is one of many reasons experts say our children's waistlines are bulging. There are many others: increased hours spent with TV, computer and video games; the suburbanized culture that makes it easy to drive but difficult to bike or walk places; phys. ed. requirements are dropping; the prevalence of fast and junk foods that are high in fat and sugar; increased soft-drink consumption; a fast-paced lifestyle doesn't allow for regular meals; larger and larger serving portions at restaurants; and single parents who can't monitor their children's eating habits as well.
Most of the problems connect to others.
"Children used to walk to school. Today for various reasons they don't. We don't have sidewalks, and there are safety issues," Perry-Burst says. "So many children, when they go home from school, are on the computer or in front of the television. In past years, children spent a lot of time outdoors. Then the reality is we're taking in so many extra calories that I'm not sure it's possible to exercise enough to compensate."
For instance, a child drinking one or two soft drinks a day will take in an extra 300 calories a day, gaining about 2 pounds a month.
Physicians recommend that children get at least 60 minutes of exercise a day, including 30 minutes of continuous activity. Predictably, many aren't getting that. A National Children and Youth Study found that 20 to 30 percent of 10 to 17 year-olds get less than a half-hour of exercise. Another common measure is the number of steps taken per day. The President's Council on Physical Fitness and Sports recommends boys take 13,000 steps a day and girls 11,000 steps; others use 10,000 steps as a good measurement. But Chavez says that studies have found a noticeable drop in the number of steps taken between 6th and 8th graders, corresponding to a higher BMI average for the older kids.
One way the health department is trying to deal with the problem is by getting to the kids as early as possible, at pre-school and day care centers like Kelley's. "The influence we have on them is great. By the time they go home, it's time to eat, bathe and go to bed," Kelley says.
A pilot program called "Fuelin' and Movin' for Life" began this year at five pre-school programs involving about 200 children.
The idea is to give the kids an understanding of good nutrition and to incorporate as much physical activity as possible. The pre-schools are given supplies and activity lessons so they have a more formal way of incorporating those two elements into their curriculum. The program also tries to teach and involve the parents as much as possible.
The pre-school phys.-ed. component isn't geared at competition as much as developing motor skills and getting kids comfortable doing physical things. It can involve dancing around to music.
"It's all about children learning to do things successfully: dribbling a ball, tossing and catching, the balance beam, eye-to-hand coordination," says Perry-Burst. "Those are things that if a child does not develop they will be reluctant to participate in physical education."
"By the time children are 5 and 6 years of age, the pattern is already there. If a child is not comfortable with play activity—even if it's a good program—they may choose to be inactive," she adds.
Kelley will sit down with her kids at lunch and talk about what they're eating. She says her pre-school kids are much more open-minded than the school-aged children.
"If you do it now, they soak it up. If you wait until school age, they want to eat what their peers eat," Kelley says.
The Learning Environment
Pre-school might be the most formative years, but there's still plenty of damage or good to be done after that. Knox County schools are relatively unique in that they have a nutritionist, who develops curricula and advises the cafeteria staff.
One way the schools are trying to teach kids about fitness and nutrition is by integrating health and fitness education with other subjects, like science, biology and math.
"One of the things we're trying to teach children is to eat a variety of foods, and one of the ways we're doing that is to have them grow food gardens," Wilson says.
Students get health education throughout elementary school and then take two-week courses in both high and middle school, Wilson says.
Physical-education requirements were slackened about a decade ago in an attempt to make curricula more flexible. "I think it was allowing for some diversity, so school officials could create schools most needed in their neighborhood. If a child needed more time reading they could sacrifice some phys.-ed. time," Boring says.
But for some schools, cutting down phys. ed. was also a way to save money in time of tightening budgets. But it happened at a time when kids were getting less exercise.
In Knox County, students get 30 minutes of phys. ed. a week in kindergarten and they get two 30-minute sessions each week in first through fifth grades, Boring says. In middle school, the state only specifies a "planned program," she says, but most middle schools in Knox County have two six-week gym classes.
In high school, the state requires a wellness and fitness class in 10th grade. Knox County offers several other elective classes, but nothing else is required.
"We are pretty frightened by the number of obese young people," says Boring, who has been teaching since 1980. "I'm talking about young children—kindergarten and first grade—who are coming into school with a perplexing task ahead of them for their rest of their lives. They've already got established habits, and we've got an hour a week in elementary school to try to turn that around."
In Boring's dream program, students would take phys. ed. every day. The class would take a more specific look at overall health, bringing in science and math where appropriate. "Instead of physical education as most people picture it, it needs to be a wellness program, with less emphasis on team sports. We need to be gearing the kids toward a daily fitness program."
The School Twinkie Fund
Some think the school's policies work against teachers' good-faith efforts to promote health. Like schools around the country, Knox County sells high-sugar and high-fat snacks and soft drinks to students through vending machines.
The county certainly isn't alone—75 percent of the state's elementary, 78 percent of middle and 85 percent of high schools have vending machines, according to the advocacy group Action for Healthy Kids.
"It is a dilemma for the schools. But we can't afford to give our children cognitive ability and throw them away physically," says Perry-Burst. "Their academic ability by itself will not make them productive. They have to have health.
"If you do a lot to establish good eating habits but put children in an environment with a lot of bad choices," she adds, "it's going to make it hard for them to continue to make good choices."
The Knox County School District either doesn't think it's important or doesn't want to know how much money the vending machines are bringing in. The money students spend on vending is buried in a line item with other so-called "resale" items—supplies sold at the school store, fund-raising events, etc.—reported to the administration.
Vending machines are not allowed in the Knox County elementary schools, and the ones in the middle and high schools are supposed to be turned off during lunch hours. The profits are required to be spent directly on students, not on teacher salaries or capital improvements, says school spokesman Russ Oaks.
But otherwise, control of the machines—what is sold in them, where they're placed, what the money is used for—is left with each school's principal.
Depending on the school, the machines sell a wide range of things, Wilson says. "Anything from Twinkies to soft drinks to crackers to water. Soft drinks are the biggest sellers. We are encouraging principals to put in healthier choices.
"It's really a big issue," she adds. "Our state does not fund the schools properly, so the schools have to depend on extra revenues." Kids certainly have healthier options in the cafeteria. Mary Lou Henry, Knox County Schools food service director, says the cafeteria strives for a balance of foods and avoids high-fat, high-sugar foods. The school is also starting a Smart Lunch program in some schools for students trying to control their weight. It will be a balanced meal with limited calories. And staff volunteers will walk with the students for 10 or 15 minutes after lunch, Henry says.
"I'm finding students are becoming more nutrition conscious. They're more interested in their diet and what goes into their bodies," Henry says. "I know that there's a lot of attention nation-wide that obesity is on the increase. I think that is true.... But the majority of them are not in the overweight category."
10 Exposures
The kids and parents have separated into two groups in Children's Hospital's nutrition course.
Juliann Chavez is talking to the moms about getting the kids to try new foods. "We want them to learn healthy habits by asking them to try things," says. "It takes about 10 exposures to a new food before children will start to eat it."
She warns them about punishing them for not eating broccoli or salad or rewarding them with dessert for eating it. "We don't want to threaten them with punishment. I always hear people saying I didn't get my desert when I was younger, so now I always want it. Reward them with praise."
Then the kids join their parents again, and Chavez takes them through a makeshift jungle-fitness course, where the kids and parents ride a banana beanbag, jump rope, punch at a wall with boxing gloves, leap up and grab an imaginary banana from a paper tree taped to the wall. It takes about 20 minutes, and there's an embarrassing air of artifice to it all—working out in a conference room while the adults smile and nod approvingly, pretending that this is somehow fun.
When it's done, the 13-year-old boy waves his arm toward the door, an unspoken command to his mom that they're leaving now. He bolts out the door as she politely thanks Chavez for her time.
People can fall into eating and activity patterns disturbingly early in life—as young as age 2. Which makes the childhood obesity patterns seem quite bleak and hard to break.
But Chavez sees the problem as similar to smoking or HIV—persistent education can make a difference. "I think we're always learning," she says. "At any point, changes can be made."
July 31, 2003 * Vol. 13, No. 31
© 2003 Metro Pulse
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