Childhood Obesity

by Deb Richards

Anyway you look at it, Jo is not a pretty picture. The poor kid’s body is so packed with fat, he used to choke in his sleep. The operation to ‘unclog’ his breathing was complicated by several other ills indicating his system is facing a crisis. His fatty liver is a warning that cirrhosis may develop; ‘bad’ cholesterols are cramming his arteries, heralding the possibility of heart attack; and high levels of insulin point to diabetes on the horizon. Apart from that his feet hurt.

Jo is suffering from the gross end result of stuffing himself with treats. He weighs 50 kilos, and is just six years old.

Shocking as it is, it seems this is all perfectly normal for someone in the modern world. “Our bodies were designed to defend fat stores,” says Louise Baur, Professor of Paediatrics and Child Health at Sydney University and the Children's Hospital at Westmead in NSW. “People who are overweight are having a normal response to an abnormal environment.”

Up until the 1970’s things were pretty well OK. Most of us didn’t eat more than we needed. But we’ve engineered a new millennium where kids have sugary fatty foods at their fingertips, they watch a lot of TV, and they’re driven everywhere in cars.

Overweight is so normal here that Australia has become the second fattest nation of kids in the world, and there’s evidence that the rate is accelerating.

“Jo’s case would be at the severe end of the spectrum,” says Professor Baur. “But we are now seeing full-blown features of diseases in children that previously only developed well into adulthood.”

It’s not that parents aren’t caring for their kids. Accidents are the biggest cause of death in children, and we’ve strapped our kids into life with seatbelts on.

Food has become one of the few things we let our kids ’do’, according to Dr Karen Campbell, a researcher at the School of Exercise & Nutrition Sciences at Deakin University in Victoria. “We restrict so much in their lives. We don’t let them ride bikes, we stop them climbing where it might be unsafe, we think it’s not fair to restrict food as well. I think it’s often used as an emotional reward and as compensation,” she says. So buns and biscuits, cheezels and soft drinks fill up the young tummies of the nation.

While we’re cushioning children from accidents when they are young, it’s at the cost of things that will kill them as adults. Where are the safety helmets as they over-eat, under-exercise, and head towards strokes and heart attacks, high blood pressure, diabetes and osteoporosis. Evidence is stacking up that the health decisions we make for five-year-olds now will still be shaping their lives when they are 50.

“The problems of childhood are an immediate ticking time bomb for the future,” says Professor Baur.

Autopsies of children as young as three who died by accident in the US showed they had fatty streaks forming on their main heart artery. These are warning signs that adult heart disease may develop.

Sydney researchers announced in may this year, they had found vascular disease in a group of overweight and obese children whose average age is 11.

“We were really surprised at the amount of abnormality we found,” says David Celermajer, Professor of cardiology at the University of Sydney, “It was far greater than we expected even in children only mildly to moderately overweight.”

Professor Celermajer says the artery damage is reversible in the young. “A second study we did showed that overweight and obese kids who went on a healthy diet and exercised showed a sustained improvement.

“It’s an alarming set of findings. It’s a clarion call for a lifestyle change,” he says.

An increasing number of Australian children also have the tell-tale signs that insulin levels are going wrong, because their systems are swamped with sugar- and this is a precursor to the development of diabetes.

Professor Baur says children developing diabetes is a health catastrophe. “The longer you have the disease the more likely it is you will develop significant complications- small and large vessel disease leading to blindness, circulation problems and amputations, heart and kidney disease.”

It is a burden to the individual, but it’s also a burden to the community. And it is all entirely preventable. Once full-blown diabetes has developed, it is there for good.

Other disease patterns set in train in childhood are not reversible. Osteoporosis is one. Dr Michael Booth, co-director at the NSW Centre for Overweight and Obesity at Sydney University explains: “High impact physical activity and a good diet with calcium is essential for building bone mass during the growth spurts of childhood. After adolescence no more calcified tissue develops. If you miss the boat, you’re stuck with what you’ve got.”

Another irreversible process is the number of fat cells we can develop. Fat cell numbers increase through adolescence, after which it seems the number is fixed. If a child becomes obese (more than 60% body fat), existing fat cells fill to capacity, and then more cells are produced to store the excess fat.

“It’s fairly well established that you can never get rid of these extra cells, you’ve got them for life,” says Dr Booth. “All you can do is diet and exercise to reduce the amount of fat that’s in them.”

While many parents know eating behaviour and exercise are the biggest determinants of long-term health, getting the kids to fall in line seems impossible. The craving for supersize everything, and the chorus of complaints at the mere suggestion of a walk instead of afternoon TV is a formidable challenge.

Dieticians advise taking it in bite size chunks. They draw on rafts of research to make a list of do’s and don’ts, that will establish healthy, happy and long living children. They urge you to remember to set the example you want your own children to follow, because children will copy you.

Keep offering rejected foods:

When kids screw up their faces at food, it’s usually interpreted as “I don’t like it”. It’s more likely to be a case of “I am not used to this.” Researchers believe it dates back to survival behaviours where the odd berry could kill. Studies have shown it takes up to 15 exposures before a child will accept a new taste.
It helps if you react in a low-key way, or not even respond. “Keep the door open” to them liking it in the future. It’s wise to leave a few days or even weeks before offering it again.

Accept a few bad manners:

If you do keep offering foods to children, you have to allow them to taste and spit out. Parents can go crazy at the mess and slobber, but it is about educating taste buds.

Avoid Bribery:

“Come on, eat your vegetables and then you can have some ice cream”, may provoke the exact opposite result to the one you intended. It reinforces that the vegetables must be disgusting. The key is to set a good example. Let them see you eating and enjoying the food while excusing them from having to, or encourage them to have a taste.

Avoid Force:

Studies show that children develop antipathies to foods they are forced to eat. It is a negative experience associated with parental control.

Offer healthy foods:

Some parents will go to extraordinary lengths to make sure their children eat something, cooking three different meals if they have to. The days of short order cook are over. Prepare one nutritious meal, with at least one thing you know they like, then sit down to eat. Face objections with a cool response, like: “This is what we’re eating, if you don’t want any you may be excused.”

Keep the portions moderate.

The whole energy requirement for a 5 year old is about 5,000KJ per day. Commercial serve sizes of take-aways tend to be overly large, and homes are copying the pattern. Educate yourself about energy levels in different foods and don’t pile up the plate.
Stick to main meals, with one snack in between if they are hungry. Stick to core foods or low kilojoule foods for snacks: low fat Yoghurt, dried fruit, lite cheese and rice crackers, fresh fruit?.

Keep all the bad stuff for occasional treats:

Don’t fill the cupboards with high kilojoule snacks. “I know it’s obvious,” says Dr Clare Collins, “But many people just don’t think of not buying the stuff. Any of those ‘dip and dunks’ are a problem.” If children are hungry they will eat anything, so fill the larder with nutritious food, and have a bowl of colourful tempting fruit within reach.

Avoid being over-controlling and puritanical:

The more restrictive parents are about food, the more it has the opposite effect. Children who are given precise amounts of food and no more, do not learn to limit their appetites. In fact the more likely they are to binge when confronted with unlimited choice.
The answer is to be relaxed, at the same time as you promote healthy eating.

Can the juice, and have water at meals.

The longer you take to eat, the more you have a chance to feel full. There’s a bio-mechanical system: the chewing itself sends messages to the brain, the stomach distends a little to accommodate the food, and as food passes to the intestine it sends messages to tell you to stop eating.
It takes about 10 minutes to eat an orange, whereas a small tetra juice, which has the same KJ as 2 or 3 oranges can take less than a minute. A quick intake of food bypasses the feedback system.

Turn off the TV and eat meals at the table

The single most important predictor of being overweight is eating while watching TV. Research by Dr Karen Campbell shows that it outstripped 8 other variables, including types of food and eating habits. Other research shows that without regular mealtimes, consumption of lollies and fast foods increases.
Kids who sit with the family at a meal table eat more fruits and vegetables, and are less likely to skip breakfast. They’re also more likely to join in conversation and eat what’s provided.

Make exercise a routine.

Organised sports and informal activities ward off weight. Parents must be part of it. Don’t expect an active child if you lounge around!

Deb Richards was a founding editorial board member of motherInc. Here is is sharing some great reading with the permission of the Australian Financial Review.