Preventing Childhood Obesity: A Multi-pronged Approach

It's hard to imagine, at least in the short term, a quick pharmacological fix, a magic pill to cure childhood obesity," said pediatric endocrinologist Francine Kaufmann, M.D., at the 2000 annual meeting of the American Obesity Association (AOA) held in Washington, DC, in September. "We have to address this problem at multiple levels of the environment. If not, we'll pay the price in human life and economic burden on the health care system," she warned.

As the percentage of overweight and obese children continues to climb—it has doubled in 6 to 17 year olds in the last 30 years¹—so does the incidence of type 2 diabetes, hypertension, cardiovascular disease, hyperlipidemia, and psychosocial disorders among these children. "It's not unusual these days for me to see a 200 pound 8 or 9 year old," said Dr. Kaufmann, describing her young patients in treatment for diseases traditionally seen among adults. As President elect of the American Diabetes Association, she expressed particular concern about the "epidemic" of type 2 diabetes in overweight and obese children and youth.

The urgent need to develop effective strategies to reverse the rise in childhood obesity was echoed by other expert speakers. William Dietz, M.D., Ph.D., Director of the Division of Nutrition and Physical Activity at the Centers for Disease Control and Prevention (CDC), described how family, community, health care providers, and media influences could all help to increase physical activity and support good nutrition among children. Dr. Dietz called for "legislative champions" to support Federal agencies now positioned to move forward on research and education programs. He also suggested revisiting health prevention programs that have already proved effective among youth, such as those related to smoking.

Children and adolescents with a Body Mass Index (BMI) between the 85^th and 95^th percentile are currently defined as at risk for overweight. Those with a BMI above the 95^th percentile are overweight.

CDC Growth Charts: United States 2000

Howell Wechsler, Ed.D., M.P.H., a CDC health scientist in the Adolescent School Health Division, outlined several strategies for shaping the psychosocial environment of a school to support physical activity and healthy eating. "Schools need supportive policies, health promotion services for staff, audio-visual cues to action, and incentive activities," he stated. He commended the state of West Virginia for its policy banning soft drinks in elementary and middle schools, and prohibiting food high in fat or sugar from being served at school. Dr. Wechsler also described the CDC KidsWalk-to-School campaign, which helps communities and schools build exercise into children's daily routines by developing safe routes to school.

Speakers lamented the dramatic reduction of physical education classes, intramural sports, and even recess in both elementary and secondary schools. At the same time, a new survey released by AOA at the conference found that parents oppose these trends. Almost 80 percent of 1,000 parents surveyed do not want physical education classes in their children's schools to be sacrificed for more academic classes.

Judith S. Stern, Sc.D., R.D., director of a clinical nutrition laboratory funded by the National Institutes of Health (NIH), presented the nationwide survey findings. Almost 30 percent of parents surveyed are "somewhat" or "very" concerned about their children's weight. In fact, parents ranked "being overweight or obese" about equal to alcohol as the greatest risk to their children's long-term health. "Considering the strong public education campaigns on alcohol we've seen in the last 20 years, it's significant that obesity is such a strong presence on parents' radar screens," said Dr. Stern.

Morgan Downey, J.D., AOA's executive director, suggested that health care professionals speak with local PTAs and school boards to "connect the dots" between fast food lunches, fewer physical education classes, and high rates of childhood obesity with accompanying chronic health problems. Health care providers, he noted, "can also provide accurate information about childhood obesity to parents, schools, and the media at the local level." This information, he explained, can help shape policies for individual communities about school food, intramural sports fields, or safe playgrounds.

Marc S. Jacobson, M.D., F.A.A.P., Director of the Center for Atherosclerosis Prevention at Schneider Children's Hospital in New York, spoke of the pediatrician's role in obesity prevention. "Health promotion is the primary goal," he stated. "The family, not the child, is identified as the patient." For children 2 to 7 years old, he explained, weight maintenance is the goal, unless there are other health complications. For those age 8 and older, weight loss is targeted only for those children whose BMI is above the 95^th percentile, unless complications are present in those above the 85^th percentile. Dr. Jacobson described the pediatrician's role as a broad one, "from anticipatory guidance and identifying family risk factors, to advocacy." s

1. Chronic Disease Notes & Reports, Vol. 13, No. 1, Winter 2000, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention