OBESE? NOT MY CHILD! By Mark B. Levin, M.D. The Pediatric Group, P.A., Princeton

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Partaking in fast foods, eating in front of the television and the computer, having sedentary jobs and living in a high stress society are well known to have partnered in America to cast the curse of being overweight on our population. The American dream was written for the stage set by the desire to escape from hunger, poverty and persecution to the land of opportunity and streets paved with gold. Lore of frail, gaunt, starved, illness-ridden ancestors from the inception of the country through the Great Depression haunt our national consciousness. No wonder generations of Americans have been reared on the admonition that food should not be left over, that rich foods are desirable and that skinny children are more likely to become ill. Bettering ourselves has become the thread used to weave our national moral fabric. Being overweight had become a symbol of success. More work meant more money; more money meant a greater ability to buy more food and to be secure from the ravages of the world.

But the birthday balloon has finally burst. We know now that being overweight, far from being a blessing, is a scourge. The couplet of excess weight and inactivity have been implicated in high blood pressure, heart disease, diabetes, osteoporosis, osteoarthritis and a host of other maladies. Americans are finally realizing that trim and active are more desirable attributes than fat, dumb and happy. How can we change our mindset with regard to food to better jive with our new credo? Although it is certainly never too late to change (even the elderly can add happy and functional years to their lives by adopting a healthier lifestyle), our main thrust must be to encourage our current population of children to espouse the attitude that some foods are detriments.

We are certainly justified in severely curtailing cigarette advertising and sales in light of the overwhelming evidence that cigarettes cause chronic bronchitis, emphysema and various cancers. We now tell our children that cigarette manufacturers sell cigarettes to get money regardless of the health consequences to the users. We also know with certainty that a high fat, high carbohydrate diet increase cholesterol levels, that a high cholesterol level is a primary risk factor for heart attacks, and that heart disease is the leading medical cause of death in the USA. Yet, we do not educate our children that the recipe for baked goods includes shortening and that bakeries concoct the recipes so their products taste good in order to sell more product regardless of the fact that their product, much like cigarettes, may lead the user to an early grave! Most adults do not realize that although heart attack symptoms usually manifest in adulthood, fat is deposited in the aorta as early as age three and fat begins to accumulate in the coronary arteries by age twelve.

We are not suggesting that baked goods be outlawed. We are, however, promoting the notion that desserts could be fruit rather than baked goods. Children should not be made to finish the food on their plate. If unhealthy foods were not kept in our homes then children would not be used to eating them. Parents should act on their knowledge that fast food take-out for dinner is generally inadvisable. Parents must be proactive in minimizing the food advertising children witness on television. Parents should insist that school lunch menus be redesigned to emphasize low fat, low salt foods and snack and soda vending machines be removed from schools. We are encouraging parents to teach their children that the foods that nature provides (fruits, vegetables, cereal grains, nuts, seeds and meats) are healthy to eat, whereas foods that come from a factory in a box are best avoided. This is a distinction that is simple for children to make. Healthy meal time habits include keeping the food reservoirs (the bowl of mashed potatoes) off the table, not offering a second helping unless the child asks for it (and keeping it smaller than the first) and choosing to eat healthy foods as a good example.

After this huge harangue about the evils of high fat, high salt, high carbohydrate foods, you may be wondering how to tell if your child is overweight. The easiest way is to ask your child's pediatrician to show you your child's growth chart and to calculate your child's body mass index (BMI). A child's weight percentile should be in the same general vicinity (within twenty percentile points) as the height percentile. For most, the weight percentile should be the same or less than the height percentile. For those with a heavier skeletal structure, the weight percentile may be slightly more than the height percentile. Furthermore, a child's proportions should be fairly constant as he or she grows. A child's weight percentile should not track from below the height percentile number to above the height percentile number in successive years. The BMI is calculated by multiplying the child's weight in pounds by 703, then dividing that number by the child's height in inches, then dividing that number again by the height in inches. The normal BMI varies by age. You can ask your child's pediatrician to plot it out for you on the reverse of the growth chart for children aged two to eighteen. Alternatively, you can find all these charts on line at http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/charts.htm. If your child needs specific calorie, fat and carbohydrate limits, ask your child's pediatrician for advice or for a referral to a pediatric nutritionist.

All overweight children do not have high cholesterol levels. All thin children do not have low cholesterol levels. It is well established for children, as well as for adults, that exercise helps lower cholesterol levels. Although exercise alone is not enough to control weight, it is difficult to eat while exercising! How much activity is enough? To effect a change in cholesterol, a child must exercise continuously (not stop and go as is the case in basketball or soccer) for at least twenty minutes at least three times per week. The exertion should be intense enough to cause increased heart and respiratory rates and perspiration. The added benefit for adolescent and adult females is that weight-bearing exercise strengthens bones.

We must be careful about our explanations to children, too. In our fashion-conscious model-envy society, we must not over-emphasize thinness so as not to encourage eating disorders (anorexia or bulemia). We should keep our children's focus on a healthy lifestyle. Nature will take care of their proportions. Although genetics plays a pivotal role in determining cholesterol levels and body habitus, if we teach our children to eat a healthy diet and stay active, we have the best chance of optimizing their cholesterol levels, keeping their weight in proportion and keeping their hearts healthy.

Dr. Mark B. Levin 

Dr. Levin has been a member of the staff at The Pediatric Group since 1977. Currently an attending Pediatrician at the Medical Center at Princeton, he has been Chairman, Department of Pediatrics, Medical Center at Princeton, 1984 to 1986, 1989 to 1992, and past President, Medical and Dental Staff, Medical Center at Princeton, 1987 to 1988. Dr. Levin has served on numerous Departmental and hospital committees. He has published original articles both while at Upstate Medical Center in Syracuse and at The Pediatric Group. He has a wife and three children. Dr. Levin enjoys alpine skiing, jogging, hiking and camping, travel, computers and racquetball.

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