The Problem: According to the Centers for Disease Control and Prevention, almost 13 million infants, children and adolescents in the United States from the ages of 2 to 19 are obese. In percentage terms, 32% of children and adolescents are overweight and 17% are obese. Adult and pediatric obesity account for 5 to 7% of national health expenses and ranks higher than smoking and drinking in its effect on health. This is clearly a national health crisis as pediatric obesity carries a higher risk for mental, physical and emotional conditions including hypertension, insulin resistance, non-alcoholic fatty liver disease, sleep apnea and societal victimization.
Obese infants, children and adolescents cross all social and economic categories but those at highest risk are from low household incomes in rural communities. African-American, American Indian and Latino children are at high risk.
Causes: We have all heard the term “nature (genetics) Vs. nurture (environment). How much of a condition is actually hard wired into our genetic structure Vs. how much of a condition is caused by environment including parental modeling. Obesity is not unlike other physical and mental conditions in that both genetics and environment are found to be causal. Research shows that up to 80% of body weight variance may be attributed to inherited factors. Yet while there has been little change in our genetic makeup over the past 40 years, pediatric obesity has tripled. Within a human sub-population then, we can safely say that genetics and external factors are creating the problem.
Taking a look at environment let’s briefly review these three key areas
2) physical activity
3) parental modeling.
1) Diet: Low income families with limited resources often look to the fast food industry for high calorie, inexpensive food. Looking beyond economics, a two parent working family may struggle with the time needed to shop and prepare healthy foods. And certain cultural eating habits engrained in families may be difficult to break. Sweeteners, including high fructose corn syrup, are of concern. Analysis of the U.S. food supply shows that 70% of processed foods contain sugar while consumption of soft drink and juices has increased five times since 1950.
2) Physical Activity: Children who live in low economic regions with minimum resources may not enjoy an environment conducive to safe physical activity. Other considerations for the absence of physical activity are television viewing time, other children to play with and mother-child interaction.
3) Parental Modeling: Regardless of the family’s socio economic status, poor parental modeling influences the diet and activity habits of developing children.
Educating parents and children about the benefits of “negative energy balance” is key to obesity reduction. The concept is simple as it explains that calories consumed should not exceed calories expended. The concept is also called energy balance. The most effective tool to create an energy deficit is simply to control caloric intake.
The United State Department of Agriculture has developed a system to facilitate healthy eating called Choose My Plate. (www.choosemyplate.gov) Choose My Plate encourages food choices with variety and nutrition, less saturated fat, less sodium and less added sugars. USDA makes the program fun and memorable by emphasizing the following easy to remember guidelines: Make half your plate fruits and vegetables. Make half your grains whole grains. Move to low fat and fat free dairy. Vary your protein. Compare saturated fats, sodium and added sugars in your foods and beverages.
Food choices alone may not eliminate obesity in a child. However, improved food choices coupled with physical activity increases calorie burn and negative energy balance. As an added bonus, regular physical activity has been proven to improve cognitive performance.
Modifying behavior to insure that improved food choices and increased physical activity are woven into family behavior may be a difficult task without counseling. Counselors are not only able to educate families on the benefits of life style changes, but to help develop a new parental model, provide suggestions for positive reinforcement, suggest motivational strategies and integrate a whole-family approach to wellness. Regardless of the recommended therapy, the entire family must engage in the remodeled lifestyle in order to increase the chances of success. A trained licensed counselor can guide a family to this end.
Colin B. Denney, Ph.D., is the Director of the Pacific Psychology Services Center in Honolulu, Hawaii, he is a Child Psychologist Honolulu.