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Fat kids: They're often made, not born

But it doesn't have to be that way

Mark Diamond, M.D.

When I was 8 years old, going to grandpa's house every Sunday for brunch was exciting. Pop was a big man with a huge appetite and nothing pleased me more than eating as much as he did.

Plates of pancakes smothered in butter and syrup disappeared as I stuffed myself. Everyone in the family thought that it was cute that I ate so much; but the result is that I am overweight. Even today, it is an unbelievable struggle to maintain control.

It seems that not a day passes without a newspaper article or TV report concerning the increasing problem of childhood obesity. Recently there was an announcement that the consumption of fruit juices by children was a major source of excessive calories and the use of the juices should be curtailed, using other foods and fluids for nutritional needs. One third of all schoolchildren in Pennsylvania are obese. Is this much ado about nothing? After all, children are often chubby as youngsters, but slim down as they get older.

Unfortunately it appears that obesity is indeed becoming a national epidemic. And, as often the case with health issues, the problem begins in childhood. Obesity is defined as the excessive accumulation of body fat relative to one's total weight. We measure body mass index (BMI) to assess body fat relative to height. Boys and girls differ as they grow over the years and mature. The guidelines for children are both age and gender specific. Experts tell us that if the BMI is greater than the 85th percentile for age, the child is at risk for long-term obesity. If greater than the 95th percentile, the child is obese. Remember percentiles tell us how your child ranks when compared with others. For example the 70th percentile means that 70 percent of the children are below that number while 30 percent are higher.

The causes of childhood obesity are many. Simply put, the calories ingested are more than the calories expended. There are clearly familial factors that increase the risk of obesity. A child with obese parents is at risk of being overweight. Whether this is due to an intrinsic metabolic problem, a reflection of poor eating and exercise habits, or both, is not clear. Although there are medical conditions causing weight gain such as hypothyroidism, Prader-Willi syndrome and Cushing's disease, these are rare.

Low-energy output related to inadequate exercise among children is on the rise. The time spent watching TV, playing video games, and sitting in front of a computer is estimated at several hours per day. Only one third of elementary school children have daily physical education. Despite assorted sports activities, many of our children are becoming couch potatoes.

Being obese as a child may lead to hypertension, type 2 diabetes, adult-onset cardiovascular disease and arthritis. Poor self-esteem and depression also are common among obese children.

Correcting childhood obesity requires effort in three areas. Increasing daily exercise is an obvious answer. but this should be divorced from other activities such as school, scouting or sports. Start slowly with 10 minutes per day and build to reasonable time such as 30 minutes per day of activity. This may include bike riding, swimming, or brisk walking.

Good eating habits are crucial -- avoid extreme or fad diets. One simple approach is to control portions and reduce the overall calorie intake 15 percent to 20 percent. This means that all foods are reduced no matter whether "good or bad." Thus no fighting over foods, but reducing by one cookie, one spoon of peas, or one can of soda at a time.

If all else fails, there are some weight loss programs for children. If people could make only one change, I would encourage families as a whole to have active lifestyles.

Parents, do not ignore the risk: Start early, in consultation with your pediatrician, and promote exercise and good nutritional skills for your child.

I wish that more effort had been made to teach me as a young child the hazards and risks of allowing my weight to be the problem that it is.

Mark Diamond, M.D., has been in pediatric practice for 27 years in the South Hills, PA. You can reach him at

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