Childhood Obesity – Step by Step Behavioral Changes

March 27, 2012 1:29 PM with Dr. Goutham Rao

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Between the sugary drinks, video games and plethora of fast food options, it’s no wonder that childhood obesity is on the rise. Join Goutham Rao, MD, primary care physician as he answers your questions about how to institute incremental behavioral changes into your child’s every day routine to help with weight loss. Learn more about how to keep your child fit, trim and happy. Your participation and early questions are welcomed.

Angela (Moderator) - 1:20 PM:
Welcome! Today’s chat: Childhood Obesity – Step by Step Behavioral Changes will begin shortly. Please start submitting your questions and Goutham Rao, MD will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the, Pediatrics Nutrition Guide page on our website. We will do our best to answer all of your questions, but because this is such a popular chat, the physician may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.

Dr. Goutham Rao (NorthShore) - 1:21 PM:
Thank you for joining us for this chat about the important issue of childhood obesity.

  Karen (Evanston, IL) - 1:31 PM:
What is the difference between sugar, high fructose corn syrup and other sugar substitutes? Is one better than the other in terms of managing my child’s weight?
Dr. Goutham Rao (NorthShore)
The difference is essentially the source of sugar as far as the difference between table sugar and high fructose corn syrup. Sugar subsitutes, whether synthetic or natural, have few or any calories, unlike sugar. In general, it's best to avoid beverages which contain sugar in any form or sugar substitutes in children, and to minimize sugar consumption in other forms. When asked what a child should drink, I also have the same response: "low fat milk or water only."

  Pamela (Lisle, IL) - 1:33 PM:
My daughter is five and is slightly overweight. We do eat healthy (most days) and she does get moderate exercise. At what point do I need to seek medical attention? I myself as a child was a little heavier, but thinned out once I went through puberty.
Dr. Goutham Rao (NorthShore)
Excellent question Pamela. The first step is to assess your daughter's habits carefully. Use a simple tool such as the "Big Five Tracker.:: Even active children with a relatively healthy diet often have some unhealthy habits. Make a strong effort to change these. Don't worry about your daughter's actual weight. Once you've committed to healthy habits, her weight status will naturally improve. If she continues to gain weight despite healthy habits (a high big 5 score, for example), speak to your physician.

  Chris (Wilmette, IL) - 1:37 PM:
My children watch a fair amount of TV. How much does this contribute to childhood obesity?
Dr. Goutham Rao (NorthShore)
Good question Chris. The answer is a great deal for a few distinct reasons: 1) Children who watch a lot of TV naturally spend less time doing other things like chores, sports, etc. 2) A great deal of food and beverage advertising which targets children is for high fat, high sugar foods. Children are vulnerable to such advertising and make requests for such products (and consume them). 3) Children who watch a lot of TV often combine TV with other activities, including, unfortunately, eating and drinking. They lose awareness of how much and what they're eating. I suggest you participate in TV Turnoff Week this year. No TV for a week, (Your kids will go crazy the first day or two). Once your turn it back on, they'll be less interested: I'm unable to post the link, but search for TV Turnoff Week.

  Jessica (Skokie, IL) - 1:41 PM:
What are some of the health risks associated with childhood obesity? Are there particular warning signs and causes I should be aware of?
Dr. Goutham Rao (NorthShore)
Thanks for your question Jessica. There are multiple health risks including: 1) Metabolic --- diabetes, high cholesterol 2) Cardiovascular --- high blood pressure 3) Breathing --- Sleep apnea 4) Bones and joints --- low back pain 5) Gastrointestinal --- reflux disease, fatty liver disease and the most neglected category: 6) Psychological and social problems --- depression, low self esteem, social isolation ,etc. There are now well defined screening guidelines for health risks associated with obesity. For example, all overweight or obese children with a known or unclear family history of heart disease should have their cholesterol checked. Your physician can carry out comprehensive screening based on your child's weight.

  Sarah (Evanston, IL) - 1:45 PM:
I am on the go and away for business very frequently. As a result, my children eat a lot of takeout and pre-packaged meals. Is there a limit I should place on this? I wouldn’t say that either of my kids are overweight, but I don’t want this to be a cause for concern later on.
Dr. Goutham Rao (NorthShore)
You are right to be concerned Sarah. As a general rule (and according to the American Obesity Association), takeout, fast food and similar meals should not be consumed more than once per week, regardless of your child's weight status. Last year, I asked a medical student who was working with me to carry out an experiment. I told him to prepare his own lunch at home, and time how long it took him (ignoring time to purchase ingredients, since most people go to a grocery store once a week anyway). He also kept track of the cost. Then he stood in line at fast food restaurants at lunch, purchased a meal, and kept track of the costs. Surprising to many, preparing lunch at home was not only less expensive, but took less time.

  Patricia (Chicago) - 1:48 PM:
My son doesn’t get “traditional” exercise, but he does play a lot of video games that require significant movement and energy. Can these count toward physical activity or should I be encouraging him to do something else?
Dr. Goutham Rao (NorthShore)
Thanks for your question Patricia. The answer is quite simply yes, you should encourage him to do something else. The Wii and other games have been marketed as promoting physical activity, but there is little evidence that you can achieve the same level of physical activity with them. A few years back, I was interviewed about what I thought about the Wii as an obesity prevention tool. I was very critical of it, and so Nintendo sent me one of the first Wiis. My wife used it for a couple of days, but no one else in my family, and it was certainly no substitute for walking, riding a bike, or playing basketball.

  Connie (Glenview, IL) - 1:51 PM:
How do you determine if a kid is overweight or just hasn’t had their growth spurt? I know for adults BMI is a good measurement of obesity. Is the same true for kids?
Dr. Goutham Rao (NorthShore)
Good question Connie. You can't use the "raw" BMI in kids, like you can in adults. For example, we know that an adult with a BMI of 30 is obese, but in kids, the values that define overweight and obesity, depend upon a child's age, and sex, and are measured with percentiles (>85 is overweight; >95 is obese). Percentiles were derived from data collected a long time ago when obesity rates were stable. For example, you can have a thirteen year old girl and a nine year old girl who are the same height and weight, and would have the same BMI, but the 9-year-old could be overweight and the 13-year-old could be at a healthy weight (13-year-olds are expected to weigh more). Percentiles adjust for this.

  Donna (Chicago, IL) - 1:54 PM:
My ten year old son is overweight and I am out of ideas on how to get him to be more active. He does not like playing organized sports and is also a very picky eater. I am worried that the more time I put off seeking help the more he’ll get teased by his classmates. Where can I start?
Dr. Goutham Rao (NorthShore)
Thanks Donna. My book Child Obesity: A Parent's Guide to a Fit Trim and Happy Child takes up this issue in detail. Research has shown that all children will gravitate to at least one physical activity which they can sustain and enjoy. It takes many attempts to find out which one it is. You can start by asking him (might get shrugged shoulders, and "I don't know.") In that case, try a few things out, even things you didn't consider, such as bike riding every evening, dance, even walking. Stay away from "pseudo" physical activities which don't contribute much as bowling, softball, interactive video games, etc.

  Kurt (Chicago, IL) - 1:58 PM:
How do you know the difference between “baby fat” and being overweight?
Dr. Goutham Rao (NorthShore)
Hi Kurt. First of all, the BMI percentiles we use to determine overweight or obese in children do not apply to children under age 2. Babies are evaluated according to their weight for length, and you doctor can tell you if that's appropriate or not. The main thing is promoting good feeding habits in babies (breastfeeding if possible, delay solids till 6 months, avoid all sweet beverages). You should focus on these habits, rather than worrying about baby fat.

  Amy (Evanston, IL) - 2:00 PM:
I am worried that my obese daughter will continue to struggle with her weight when she is an adult. Is there a connection between childhood obesity and adult obesity?
Dr. Goutham Rao (NorthShore)
Dear Amy. Yes, unfortunately the connection is very strong, and the older a child is when he or she is obese, the more likely he or she is to be an obese adult. An obese teenager has a 70% chance of being obese as an adult. Fortunately, if your daughter is motivated and loses weight, she can largely avoid the health risks associated with obesity.

  Virginia (Chicago, IL) - 2:03 PM:
My 16 year old daughter has become increasingly overweight since entering high school. Given that she’s going through a lot of body changes, I am not sure the best way to confront her about her weight. What suggestions do you have?
Dr. Goutham Rao (NorthShore)
Excellent question Virginia. A few core principles: (1) Don't mention the words, "fat" or "obese" in your discussion. Use the word "weight" when referring to the problem; (2) Don't ask her "if she's happy with her weight"; (3) Don't tell her things to the effect of she would feel better about herself or be more popular if she lost weight. These types of strategies can be very hurtful and cause her to shut down. A good way to start is to do the following: (1) Go online to a website (e.g. the CDC) where all of your family members can enter your height and weight and receive a BMI value or percentile. (This makes it clear you're not singling her out.) 2) Assuming her value is high, ask her if she's concerned about it. 3) Next, tell her that weight (not her weight, but anyone's) is a concern because of the health risks of obesity (high blood pressure, diabetes, etc.) 4) Ask her if she would like to work on achieving a healthier weight.

  Liz (Highland Park, IL) - 2:08 PM:
How healthy are school lunches for my children? I often don’t have time in the morning to make their lunches, but wonder if they would be better off if I made a point to make the time. I know that over the years the menus have become healthier, but is it enough?
Dr. Goutham Rao (NorthShore)
Great question Liz. Sadly, school lunches are not terribly healthy. Schools have a limited budget for school lunches and the choices they must make are not great ones. Furthermore, many schools sell "competitive foods" such as burgers and fries which children naturally select more often than the USDA approved lunch. I would definitely make the time to make school lunches (As a tip, do it the night before, and if your children are old enough, ask them to make it part of their bedtime routine).

  Joan (Skokie, IL) - 2:12 PM:
I am an elementary school teacher and have noticed over the past 10 years instead of maybe having 1-2 kids in my class who were overweight, I now have closer to 8-9 kids. In your practice are you finding that more kids are obese? Why the sudden shift?
Dr. Goutham Rao (NorthShore)
Dear Joan. You and I have had the same experience. Yes, the rate of childhood obesity increased by roughly 1% per year between 1992 and 2006 (going from roughly 6% to 20%). Fortunately, it seems to have stabilized. The reasons are complex, but some of the biggest culprits are (1) Supersizing; (2) Greater affluence and lower prices for unhealthy foods; (3) More sedentary time (e.g. video games); (4) More widespread availability of sweet beverages. The list goes on...but collectively, these changes led to a dramatic and rapid shift.

  Emily (Chicago, IL) - 2:15 PM:
My teenage son is extremely obese. My husband and I have tried to introduce new, healthier habits into our home, but nothing seems to be working. I’m starting to run out of ideas and am very concerned about his health. He does not have an interest in losing weight. What can we do?
Dr. Goutham Rao (NorthShore)
Dear Emily: Unfortunately, as the former director of a pediatric obesity clinic, I had that experience often with teenage boys. They simply are not interested, at least not at first. A couple of tips to boost motivation. Find out what his ambitions are later in life (Don't settle for "I don't know.") Most kids have some idea what they want to do. Discuss how his weight might affect those ambitions. I had a teenage patient who wanted to design video games. I told him that if he developed diabetes and his vision was affected as a result, his career in that field would be cut short. Another motivator is to have your physician screen him for obesity-related health risks, such as high cholesterol. If he is very obese, he has already probably developed some problems, which sometimes provides motivations. One of my colleagues suggests discussing dating/girls/boys as a motivator, but that's usually pretty touchy.

  Dan (Chicago, IL) - 2:21 PM:
Both of my children are at a healthy weight now, although both my wife and I are overweight. Is this something that may also happen to them once they get older? Is there anything we can be doing now to prevent it?
Dr. Goutham Rao (NorthShore)
Great question Dan. Yes, unfortunately, your weight status puts your children at risk. You have already taken an important step by being concerned. Many overweight parents are not concerned about their children's weight status. Start by following "the big five": Eliminate all sweet drinks from your family's diet; No more than 2 hours of screen time per day; Fast food no more than once per week; (4) Make sure your children eat dinner with you as often as possible (at the table); Daily physical activity as a family (usually an evening walk after dinner when you can also have discussions about school, homework, etc.)

Angela (Moderator) - 2:23 PM:
Thank you everyone for your great participation. The chat will be ending in approximately 5 minutes. Please submit your final questions.

  Robert (Chicago, IL) - 2:24 PM:
What or who is to blame for childhood obesity? It seems to me that it would be a combination between family lifestyle, eating habits and physical activity. Is that right?
Dr. Goutham Rao (NorthShore)
On one level your absolutely correct Robert. A broader view is that childhood obesity is the result of normal kids interacting with an "obesigenic" environment. When I, and assume you as well, were kids, we didn't have access to so many calories with so little effort. Many people in such environments will overconsume, be underactive, and become overweight (Think of people who gain weight on a cruise ship in just a week). So the ultimate answer is advocating for and creating a healthier environment. It's easy to blame children and families, but this is a much broader problem.

  Melissa (Chicago, IL) - 2:27 PM:
What questions should I be sure to ask my daughter’s pediatrician about her weight at her next check-up?
Dr. Goutham Rao (NorthShore)
Great question Melissa. A few basic questions: 1) What is my daughter's BMI percentile? 2) Does her BMI percentile put her at health risk? 3) Has her weight changed trajectory at all in that past couple of years? 4) Based on her weight, should she have testing for cholesterol, or diabetes...AND because it's part of my research don't forget to ask, 5) What is my daugher's blood pressure? Is it normal?

Angela (Moderator) - 2:29 PM:
Thank you for participating in our online chat today. An online transcript will be available shortly. To learn more about Childhood Obesity, read our recent blog post.

Dr. Goutham Rao (NorthShore) - 2:30 PM:
Thanks for all your great questions! I hope my responses were helpful.

This chat has ended.

Thank you very much for your participation.