The Childhood Obesity Dilemma: How Something So Simple Got Complicated

This is the first of a weekly coulmn by Dr. Besser that examines public health issues across the nation.

In a large shopping center in Northeast Atlanta, St. Joseph's Mercy Care provides a medical safety net for some of the city's poorest residents. I have volunteered with Mercy for more than a decade as a general pediatrician. Most patients have no insurance and pay what they can to be seen. One half day each week, I switch gears, taking off my public health hat and putting on my clinical one. There is something wonderful about the immediate experience of being with a child and a mother, focusing on their concerns, and trying to help them maintain or regain health.

What I've seen in my clinic is being seen across the country and is captured in statistics. More than one out of every three of children are overweight or obese, according the U.S. Centers for Disease Control. Type two diabetes -- a disease linked to obesity and previously seen almost entirely in adults -- is on the rise in children. Kids are exercising less and eating more; going outdoors less and video-gaming more.

As a pediatrician, I talk to all children and parents about healthy choices -- food and exercise are always part of the conversation.

I remember one of the many times I talked about this with a mother of Jorge, an 11-year old Latino boy who is overweight but not yet obese. Being Latino, his risk for developing diabetes was high. His mother was very concerned.

"What does Jorge like to drink?" I asked.

"Soda! I tell him no but he drinks three or four bottles a day! I know it isn't good for him."

"Where does he get the soda?"

"I buy it for him."

We talk about healthy choices: foods that should be eaten or offered every day and foods that are called "sometimes" foods, those that should only be given occasionally. Soda fits into that category. Soda consumption by children has risen by 30 percent in the past decade and now accounts for 10-15 percent of their total calories, according to a 2004 study in the American Journal of Preventive Medicine.

Combating Childhood Obesity

Jorge looks at me aghast when I ask him if he would spend his allowance on soda if his mother didn't buy it. At this point I am feeling like we are on the road to better health. If I can get her to not keep soda in the house, Jorge will drink less.

We then talk about physical activity.

"What sports does he like to play?"

"How many hours of TV, computer, or gaming does he do a day?"

"What do you as a family like to do on the weekend?"

Physical activity is the other half of the weight equation. I learn that Jorge's middle school, like many around the country, has almost eliminated physical education. No Child Left Behind, a program designed to improve academic performance, has forced academic subjects and physical education into a direct competition. While data support the value of physical education as a way of promoting learning and a healthy lifestyle, schools are judged on test scores. Only 14 percent of elementary schools, 15 percent of middle schools, and 3 percent of high schools have physical education for all students at least three days per week, according to the CDC.

Access to afterschool activities is even worse. Jorge lives in a neighborhood that is not safe for outdoor, unsupervised play and there are no readily available after-school sports activities. He spends much of his day either watching TV, playing video games, or on the Internet. Without community solutions, Jorge will not have the opportunity to develop an active lifestyle that is so important to health.

Promoting healthy lifestyles for children is a shared responsibility. There are things that parents can do such as deciding whether or not to buy soda. There are other things that go beyond what a parent can accomplish. In future columns I'll discuss some exciting programs taking place in schools and communities to tackle the epidemic of diseases that are linked to obesity.

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