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Vital Signs

Winter 2014

Childhood Obesity

Addressing Poor Habits Early Can Lead to Children Becoming Healthier Adults


In the last 30 years, obesity rates have more than doubled in children and tripled in adolescents in the United States, according to the Centers for Disease Control and Prevention. As of 2010, more than one-third of children and adolescents were overweight or obese. Pediatrician Wendy Slusser, MD, cofounder and medical director of the UCLA Fit for Healthy Weight program — a multidisciplinary approach to treating overweight children — discusses strategies for preventing and treating the problem, and when to seek help.

A lot has been said about the risks of obesity in adulthood, but what are the biggest health concerns for children and adolescents?
Recently, adult diseases have been creeping down to adolescence, and even pre-adolescence. Type 2 diabetes in children has increased with the rise of obesity, and we also see hypertension and obstructive sleep apnea that we would normally not have seen at such young ages. The most common and immediate effects of obesity during childhood, however, are musculoskeletal and stomach complaints, as well as mental-health issues. We see a lot of overweight children with aches and pains, which perpetuate the problem because then the child isn’t active. Gastrointestinal complaints are a huge factor related to obesity. And the emotional well-being of children can affect so Dr. Wendy Slussermuch, from their school performance to their long-term health, wellness and productivity. We also know that many of the long-term health risks as adults are largely determined by the age of 20, so promoting health and wellness in the early years is going to translate to a healthier adult.

At what point should parents seek help for their children?
It depends on the age. Before the child is 2 years of age, there are no body mass index standards, so we use height vs. weight. If they’re at the 95th percentile or quickly jumping up percentiles in terms of weight, that would be a red flag. You need to be looking at what the child is eating or drinking — usually it’s sugared drinks or juices that are the biggest culprits. After age 2, we have the BMI standard: If you’re between the 85th and 94th percentile you’re considered overweight, and at the 95th percentile or above you’re considered obese. When I am talking with a parent of a young child in that situation, I explain that we need to be mindful of what might be going on and what we can work on to make a difference. We do what’s called motivational interviewing, which explores the family’s confidence about what they can do to change, and ask them to make choices within the context of their lives. It is a family centered approach to behavior change. The family has to not only care about making changes, but has to embrace them.

What are some of the front-line strategies for addressing the problem, or preventing a problem from occurring?
One of the tenets of a healthy lifestyle is having routines. That includes eating three meals a day and snacks, so that you’re not going to be so hungry that you overeat. It means incorporating physical activity in your daily life, ideally totaling at least an hour a day. Among the most important from a dietary perspective is avoiding sugary drinks. You want it to be difficult to access unhealthy foods, so that healthy foods are the default. We also believe that being mindful of what you eat and when you eat is important. Family meals in the evening may be healthier than eating out.

What is the basis for your program’s approach?
We have a psychologist, a dietitian and myself seeing children and families monthly, and it’s very individualized. We spend time addressing not just the mental health of the patient but the mental health and well-being of the family, particularly the parents. If they’re not on board and not taking care of themselves, the children will have a harder time addressing their own nutritional and psychological needs. As far as diet, we are very specific about what needs to be changed and we work on small, incremental steps.

1 in 3 children is the U.S. is obese or overweightPreventative Measures: What can you do at home?

Active Playtime
Plan family activities that involve exercise. Instead of watching TV, go hiking or biking, wash the car or walk around the mall.

Healthy Meals and Snacks
Replace sugary drinks with healthy natural bevarages, such as juice and water. Avoid eating processed food and prepare more fresh meals.

More Sleep
Establish a regular bedtime and wake-up time.

Be Supportive
Children know if they are overweight and don’t need to be reminded or singled out. Don’t use food as a reward or punishment. Children should not be placed on restrictive diets unless done so by a doctor.


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