Our overweight kids: A supersized crisis
September 25, 2004
By Todd C. Frankel
Here's a fact that should stick in your gut: Today's teens are the first generation of Americans projected to lead shorter lives than their parents.
Blame fat.
The obesity rate for adolescents has tripled in the past 20 years. And more and more of these kids are hitting extreme ends of the scale, stretching to levels of severe obesity, morbid obesity and super-obesity unimaginable in generations past.
Nearly one in three children and teens is overweight today. One in six is obese.
Unless something changes soon, today's kids face daunting rates of diabetes, heart disease and pulmonary problems.
Don't be surprised, experts say. Children are growing up in a culture that encourages packing on the pounds. They are eating more calorie-stuffed convenience foods than ever, in ever larger portions. They sit playing video games and watching TV for hours on end. They attend schools where PE has been pruned from the schedule. Some children live in neighborhoods so dangerous they can't play safely outside. Others reside in sublime subdivisions without sidewalks in a car-centric world where a walk to anywhere can seem exotic.
Researchers have even coined a new word to describe this world: obesogenic.
The problem is epidemic. Public health officials are alarmed. Parents are at wit's end. The kids are getting sick. And the search for solutions is on.
The problems start early and can last a lifetime. Before they are old enough to drive, obese kids are getting high blood pressure, diabetes, sleep apnea and asthma.
Tierra Johnson, 16, of Bel-Ridge, recalls with precision the day she was told she had Type II diabetes: June 18, 2002, the week of final exams. She was in the eighth grade.
Tierra, who is overweight, was terrified. She was told she'd need daily insulin shots.
"It was just the thought of having to be on it for the rest of my life, having to stick myself," she recalls.
Since then, every day, twice a day, Tierra slips a syringe needle inside a glass vial filled with medicine and stabs her stomach with a shot of insulin.
Type I and Type II diabetes run through Tierra's extended family, but other family members developed the disease in their 40s and 50s, says her mother, LaDonna Jones.
"We've never had anyone in our family who was so young who had it," Jones says.
Just a decade ago, nearly all diabetes cases seen at the St. Louis Children's Hospital diabetes clinic were Type I. Kids with Type II were "oddities," says Neil White, the hospital's director of pediatric endocrinology and metabolism.
Type II should take half a lifetime to develop.
"Now, maybe a quarter to a third of the new diabetes cases are Type II," White says. "Type II has become a pediatric disease."
Obesity also packs a sucker punch of emotional trauma. A startling study last year showed obese kids had a quality of life score so low it was on par with kids undergoing chemotherapy for cancer.
Being overweight changes childhood.
"I am reminded every time I look in the mirror that I am fat," says Mandy Eaton, 16, of St. Peters, who is about 20 pounds overweight.
Steven Byrd, 16, dreams of buying his first car - a
sports car, maybe a Mazda 3 or 6, that he can soup up.
But at 6-foot-1 and 375 pounds, Byrd can't fit into
his dream ride. He is trying to lose
weight with the help of a program run through St.
Louis Children's Hospital.
McKinley Adams, 13, also struggles with his weight. His mother sent him to a four-week weight-loss camp this summer near Carbondale, Ill., because the doctor said he was pre-diabetic. Losing weight was his best defense against getting sick. But McKinley, a cheerful, witty kid who lives in Richmond Heights, went for his own reasons.
"When you're big," McKinley explains, "it's not so easy to hook up with a girlfriend."
Calories in, calories out
It's no trade secret. A painfully simple calculation regulates weight: Calories in, calories out. Eat more than you expend, you add pounds.
"It is just math, simple math," says Susie Nanney, director of the Obesity Prevention Center at St. Louis University.
The math is unforgiving. A single Life Saver candy every day for a year can add a pound or two. A small bag of potato chips once a month: 5 pounds. Drink a 20-ounce bottle of Sprite each day for a year instead of a 12-ounce can, and the scale will move 10 points in the wrong direction.
Throw in children's ever-decreasing activity levels, and an equation for mass obesity emerges. Only about half the nation's kids are regularly active. Daily PE class rolls dropped 40 percent in the early 1990s alone. In Missouri currently, PE requirements fall from one period a week in public elementary schools to just one credit over four years in high school. Illinois is the only state to require daily PE class, but many schools get waivers.
One study showed that children driven to school, instead of walking, miss out on burned calories that may account for two or three pounds a year.
"It's just these minute variations in energy intake that can have a dramatic impact on body weight," says Denise Wilfley, a psychiatrist studying pediatric eating disorders and obesity at Washington University.
And yet, while the math may be simple, the answers are not.
"No one wants to be fat," says Sarah Barlow, a pediatric gastroenterologist at St. Louis University specializing in childhood obesity.
"We're working to reduce the calorie imbalance. In one way, that is very simple," she says. "And yet, if it were that simple, we wouldn't be having this problem."
Not only is obesity hard to conquer, it is hard to talk about. Polite conversations dance around the topic - even in pediatrician's offices, where researchers find that doctors often fail to address the issue with their young patients and parents.
"The parents think their child is going to outgrow it. The doctor is wondering if they say something, it'll open a whole can of worms. Meanwhile, the kids get bigger," says Marilyn Tanner, a pediatric dietitian who deals with overweight kids at St. Louis Children's Hospital.
And that's the rub: Silently waiting for these kids to grow up is a losing proposition. An overweight teen has a 70 percent chance of being an overweight adult. And then the weight is even harder to take off.
One family's struggle
In Arnold, Theresa Sheline worries about her two bright daughters, ages 10 and 12, who struggle with excess pounds.
She imagines a time when her girls will be perhaps not thin, but closer to their ideal weights.
"They'll feel better about themselves," she says.
Sheline's youngest, Taylor, agrees. Just the other day a girl called her "fat." Words like that sting. Taylor would love to drop 30 pounds tomorrow. But she knows it's not that easy.
Sheline is thinking about enrolling her girls in exercise classes to complement their scooters, bikes, backyard pool and trampoline. She'd like them to walk to school, about a mile away, but school officials forbid it. The school sits across a busy road.
She also was shocked to learn that her oldest, Ashley, who joined Seckman Middle this year, has PE just once a week in the first semester. "I was like, you've got to be kidding me! I thought they should have it every day," she says.
Sheline is nudging the entire family to eat healthier. But it is hard to get the ice cream and the potato chips out of the house.
"It's like a habit," Sheline says.
"I know how you change - you don't buy it," Ashley, 12, says.
"But mom eats it," says Taylor, 10.
"And dad eats chips," Ashley says.
Ashley adds that they never have apples or bananas in the house.
Sheline says the reason is simple: She buys them and no one eats them. The fruit goes bad.
Mom knows change is needed but admits, "We're not there yet."
At the Bel-Ridge home of Tierra, who has Type II diabetes, her mother talks about how they've started eating salads. They've found a taste for spicy chicken salad. But still they eat out too often, she says. Between work, school, church and social plans, the whole family flies by on different schedules.
"When I was growing up, grandma would throw down some greens, cornbread, candied yams," Jones recalls. "Today, it's, 'Who's picking up dinner?' "
A lifestyle on the run makes changing behavior difficult, experts say.
"It's so bad with busy parents," Barlow says.
Tanner sees it, too.
"I think parents are not setting limits," she says. "It's hard. But they've got to do it."
Culture is problem, too
Addressing the obesity epidemic should not be left to parents and kids alone, says Sam Klein, a leading obesity researcher and director of the Center for Human Nutrition at Washington University.
It requires "an exhaustive effort on multiple levels."
Klein would like to see plans of attack from school systems, local and federal government, researchers and the private sector. That could include passing laws to foster the construction of subdivisions with bike paths and safe walking routes to and from schools; government subsidies for fruits and vegetables; and even a "sin tax" on high-calorie foods, like there is on cigarettes.
Such ideas are controversial and contested fiercely by groups like the Center for Consumer Freedom, a coalition of restaurants and food companies. Klein says drastic action is needed: Obesity is projected to pass smoking soon as the leading cause of preventable death in the United States.
"The burden of obesity is bankrupting us," he says.
Today, public health officials admit they've failed with the message to eat better and exercise more. So they are changing tactics.
The focus now is on attacking the obesogenic culture, says Nanney, at the Obesity Prevention Center.
The Centers for Disease Control and Prevention has given money to 20 states, including Missouri and Illinois, to develop strategies for battling obesity. The states hope to finish their plans this year.
Nanney is hopeful that the private sector also will mend its ways.
"We've seen from the Atkins craze that the industry can come out with new products, and very quickly," she says. "The industry can reform in a way that meets consumers' needs if you put the demand out there."
There are signs that companies are listening. This summer Subway kicked off an ad campaign with kids, not adults, talking about their weight struggles (and, of course, Subway's role in helping them lose weight). McDonald's has committed to phasing out "super size" options for its meals. In the past year, Kraft Foods has cut fat in 200 of its products, including Oreos and Triscuits. The international food giant also stopped advertising in U.S. schools.
Small endeavors are under way, too, like St. Louis' "Get Hooked on Health" promotion, which began this year. A Missouri Foundation for Health grant is paying to distribute pedometers in schools in six St. Louis-area counties. The goal is to reach 40,000 kids over the next three years. Pedometers - tiny devices that measure steps and distance walked - are increasingly being used to get kids moving again.
St. Louis Children's Hospital runs a small weight-management outreach program called Head to Toe. The St. Louis region's only comprehensive weight-management clinic tailored for kids is at Cardinal Glennon Children's Hospital. It treats obesity as a medical condition. Medical staff evaluate each child. Eating behaviors are assessed.
Barlow, who runs the program, sees many patients with unstructured diets full of irregular meals and snacking.
"I've seen families who've done well. But I've seen many, many who have not," Barlow says. "There are modest gains. This is a program where people need to choose to participate."
The dropout rate is high.
In the most extreme cases, doctors may try a pharmacological or surgical solution.
Last year, federal regulators gave the green light to using a weight-loss drug in children. Xenical, a drug that inhibits the body's ability to absorb fat, was approved for adults in 1998. It may soon be available over-the-counter.
Some seriously overweight teens have turned to gastric bypass surgery, which has become popular with morbidly obese adults. But it remains rare, and risky, in younger patients. It is widely viewed as an option of last resort, when a child has exhausted other options.
The surgery's long-term implications in children are unknown. But doctors compare the surgical risk against the known threat of severe obesity, and say the risk can be worth it.
Camp helps kids lose
Sometimes kids just need an extended break from unhealthy routines - an intervention of sorts.
Jean Huelsing, a St. Louis nurse, started Camp Jump Start to help kids lose weight. She is a reformed "fast-food queen" chastened by her own children's battles with weight.
"If I was bringing home Kentucky Fried Chicken, I thought I was doing a good job," Huelsing recalls. "It was chicken, not hamburger."
Her camp program is based on a low-fat diet, continual exercise and intensive health education (including a graphic show-and-tell of human cadaver hearts to illustrate the effect of fat on the cardiovascular system).
Lunch one day consists of a precise 3-ounce turkey burger on a bun, a cup of fruit salad, a half-cup of potato salad and all the salad you could want, topped with no-fat dressing. To drink: water. Some of the kids balk at the paltry offering. But Huelsing says the food is exactly as it should be.
"Americans, we don't know portion sizes anymore," she says.
After four weeks at camp, McKinley, the teen from Richmond Heights, lost 22.5 pounds. Drake Rollo, 12, of St. Charles, lost 21.8.
"I have to wear a belt now," Drake says proudly.
Drake and McKinley became best buds during camp.
"He's always backing me up. I'm always back him up," says McKinley.
"Yeah," Drake says, "we're tight."
On the last day of camp, Drake and McKinley wait with the other campers for their parents to pick them up. McKinley's family arrives first. His mother, Missie Tyson, is shocked.
"You look so good!" she says, hugging him.
McKinley shows his mother around camp before asking to do the once-unimaginable: weigh himself. He runs into the camp office and heads for the digital scale. Seeing the results, McKinley lets out a loud "Woo! Yeah!"
He finally, barely, cracked the 200-pound mark.
"199.7 pounds!" McKinley shouts to Drake, aping a muscle-man pose. Drake slaps his buddy a high-five.
A black SUV pulls up. Drake runs to the door and hugs his mom.
"I lost 7 inches around my waist," Drake says excitedly.
"Are you kidding me?" his mother, Joy Herrington, says, beaming.
"And 21 pounds," Drake adds.
"Oh, my god! Oh, my gosh!"
Soon, it is time to go.
The minivans and SUVs pull out over the gravel and hit the blacktop. The campers are leaving their oasis, a place that closely resembles the way things were a generation ago, back when childhood obesity rates were 300 percent lower, portions were smaller, kids more active.
The campers are venturing back into a culture crammed with temptations and calories. Just 10 miles down the road, they pass a flurry of colorful signs for fast-food joints and gas stations offering 44-ounce fountain drinks and "king-size" candy bars.
For now, they are riding high on their success, the inches and pounds lost.
But out here, in this obesogenic world, things are much less certain.
Source:www.stltoday.com
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