Childhood Obesity — The Skinny on a Big, Fat Problem

Circa 2008/09

As Sharon Rowland’s weight climbed to 210 pounds, she worried that her children would follow her example, especially her oldest girl.

“She likes to eat, and I was concerned about that,” Rowland says of Kylah, now 12. “I also wondered if she was getting enough exercise.”

It’s a concern shared by parents across America as childhood obesity rates for children six to 19 have more than tripled since 1980, according to the Centers for Disease Control. Packing on the pounds in youth may cause a range of typically “middle age” health diseases to strike much earlier.

“Type 2 diabetes used to be called ‘adult onset diabetes,’” says Wes Alles, director of Stanford Health Improvement Center in Palo Alto, CA. “But the name had to be changed because we were seeing younger and younger children with the condition.” In fact, some experts have warned that this could be the first generation that won’t outlive its parents.

Loss of self-esteem, eating disorders, depression, social isolation and learning problems are additional ills that can land at the doorstep of obese children.

Even without wading through knee-deep statistics on the subject, Rowland gleaned that it was important to monitor the diet of all four of her children, who, in addition to Kylah, include daughters Kennedy, 10, and Kamryn, 7, along with son Raymond, 4.

“It’s hard as a single parent,” she said, “but I knew that there were better ways to eat than the drive-thru at McDonalds.” So when an administrator at her local Indianapolis YMCA approached her about taking part in the Healthy Family Home Program, she signed up.

Earlier this year, the Rowlands completed a four-month pilot study, which was also conducted simultaneously in Chicago, New York City, San Diego and Marshalltown, IA. More recently the Eli Lilly funded program went nationwide at 1700 YMCAs.


In sessions with other families, the Rowlands learned to make healthier choices, scrutinize food labels and avoid the evil god of trans fats. Sharon Rowland lost 25 pounds, and found that the Healthy Family kit was easy to incorporate into her and her children’s daily routine.

The opening pages of the colorful pamphlet provide tips for youth to take an active role, not only in planning and preparing meals, but also in choosing family activities. The booklet’s second half addresses parental input, urging moms and dads to eat and play with their children, and to spend individual time with each kid, which may help reduce emotionally motivated eating.

Rowland finds that the lessons she learned during the program have given her children more hands-on decision-making skills, such as the ability to interpret nutrition labels and to leave fattier items right there on the supermarket shelves.

“Our family used go through boxes of Little Debbie Snack Cakes,” Rowland recalls, “but after the trans fat discussion [at the Y], we went home and threw them all away. Now, when I tell them to go pick out something for a snack, nine times out of 10 they pick out something very healthy.”

As the family’s head chef, she changed up the menu, using recipes that trim the fat, switching to brown rice and whole grain spaghetti, substituting olive oil for butter, and baking instead of frying.

For exercise, the family bikes together. Sometimes the children zoom ahead on their heelys—shoes with little wheels on the bottom. Kylah, inspired by the historic Olympic performance of Michael Phelps, now swims three days a week; Kennedy and Kamryn often exercise before bed; and Raymond recently played his first season of flag football.

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Lauren R. Cislak, manager of communications for Eli Lilly, the pharmaceutical company, worked with the Y as well as with families to establish the program. Her development team delved into the lives of people such as the Rowlands and asked, “What are your special needs?” They also made gentle suggestions such as, “Take a nice walk around the block after dinner, crank up the music and dance together.” The thinking, Cislak says, was for “families to set goals that are reasonable, win small victories, and move on to new achievements.”

The fact that kids don’t get fat by themselves is a key concept behind the Healthy Families program. “There is a context for behavior,” says Alles. “It’s reinforced through modeling of parents, their values and their sustained behavior.” Maybe the family watches TV and eats ice cream together. Or perhaps a parent is on the computer, while a child plays a video game, each munching a high-fat snack.

“Our children are doing the same things we are, which translates to normal,” he adds. If we over eat, they over eat. If we don’t exercise, they may not either.

Alles suggests that parents model healthy eating habits and fitness routines in the same way that they teach children to look both ways before crossing a street, or warn them about unprotected sex. All represent life-sustaining choices.

Trina Wiggins, MD, a Las Vegas pediatrician, also finds it pointless to expect a child to be successful at losing weight if there’s no family support.

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“The mother or guardian purchases the food, so if they’re not eating well or not working out, it’s a moot point to talk to the kid.”

Societal change over the past generation or so has helped to expand our waistlines, says Kristine Courtney, MD, director of Corporate Health Services at Eli Lilly. “We used to walk to school, now we take buses. Kids used to play outdoors, now free time is filled with video games.” Wiggins agrees: “When I grew up,” she says, “it was torture for me to be inside. I loved kickball, dodgeball and riding my bike.”

Many wag the finger at technology for giving us entertainment that we can’t put down, and for allowing us to take lazy short cuts.

“We’ve engineered physical activity out of our lives,” Alles observes. “It’s not only our passive use of escalators and elevators at the mall or in parking structures. We have created communities better suited for car transportation than for recreation.” Expansion of roads and freeways often make walking to parks or finding dedicated bicycle lanes difficult or impossible.

At many schools, the daily physical education classes of Wiggins’ day have been scaled back to every other day or even offered only as electives. Instead of a hot lunch from the cafeteria, the school may serve pizza, burgers and tacos from local fast food restaurants.

The young Rowland girls have learned to say “no thanks” to the fast stuff. Dissatisfied with the lunch choices at their schools, they bring their own. Kennedy and Kamryn also belong to an after school program called Girl Power, which stresses the importance of a healthy diet and exercise.

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Alles finds that as children gain weight, it’s harder for them to be physically active because it takes more effort and doesn’t feel as comfortable. He invites parents to examine the “connectedness” of technology use, weight gain and increased inactivity.

Wiggins sees that connection every day. “A 10-yearold who weighs 150 pounds is normal in a family where mom and dad are overweight.” She’s challenged with finding a way to deliver unpleasant news to these parents in a way that doesn’t come off as, “Your kid is fat, and it’s all your fault.”

One technique is to show parents a growth grid on which obesity is defined by body mass index (BMI), a complex calculation that takes into consideration a child’s age and sex. “It’s objective,” says Wiggins, who finds it difficult to cram meaningful discussion about childhood obesity into a 15- or 20-minute appointment. “I have found myself trying to talk a mile a minute to get it all in, but they’d come back a month later, and Johnny had gained five pounds.”

The idea that parents may prematurely bury their obese children hit home recently when Wiggins’s cousin succumbed to diabetes. Overweight and on dialysis, he died of kidney disease at 33 years old, survived by his 66- year-old mother. This experience and others, both as a pediatrician and body builder, motivated Wiggins to start OPT2BFIT, which offers fitness camps for kids (see sidebar).


“When you work on something like your weight, you can be real excited when you get started, but then run out of steam,” says Courtney. “Family provides support to get you to the end of the race.”

At Eli Lilly, she helps get employees out of their chairs and into exercises sessions. She sees her colleagues as part of a greater community of adults and children who must invest in one another to ensure that we all get a chance to live long, healthy lives.

“We have to reverse this [childhood obesity] trend in a positive direction,” Alles concurs. “There is a large gap between what people know and what they do. We have to make it so that health, nutrition and fitness are reflected in the lifestyle of the family.”

“It’s never too late,” he asserts, “to make changes that will positively influence the quality of our lives and health potential.”

Rowland came away from the Healthy Family sessions not only with better nutritional information, but also a stronger bond with her children. “We spend more time together as a family, giving each individual member a voice, no matter how big or small or young…”

Last summer, the family experienced a devastating fire that disrupted its routines, but a month later they picked up where they left off and got back to eating well and exercising regularly. “All of a sudden,” Rowland says, “my children discovered that it’s cool to be healthy.”

It’s 1982, and Trina Wiggins, a gymnast and pre-med student at Stanford University, weighs 124 pounds.

Cut to 2007: Wiggins, now a pediatrician, returns to her 25th college reunion, weighing 125 pounds.

Getting through medical school, facing the challenges of being a wife and mother, and keeping a dozen plates spinning in the air could have easily added several layers to Wiggins’ waistline. Yet she’s always maintained a focused exercise and diet regimen. In recent years, the Las Vegasbased physician—married for more than 20 years to Carl Allen, MD, and mother of Malcolm and Marcus, 14-yearold twins—has participated in fitness competitions. Now she’s trying to pass down her good habits to the next generation.

“In a practice setting,” she says, “a physician [doesn’t] have much time to talk nutrition and exercise.” While she gives parents as much information as she can, she still finds that she prescribes too much medication for early onset diabetes and high blood pressure.

These diseases point directly to inactivity and poor diet, and in her efforts to prevent them, Wiggins created Fit Kidz Consulting and OPT2BFIT, through which she hosts weeklong fitness camps that cost around $200. At camp, children engage in cardio exercises to their favorite CDs, and play games such as Portion Control Bingo, which helps them learn about nutrition and making smart choices about what they eat.

At a recent elementary school assembly, Wiggins spoke to 800 students about the value of staying in shape.

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“We showed them a cartoon of two women who go from age 13 to 60,” she says. “One rides a bike, the other a couch. One has a good diet, the other bad. At 60, the one who was riding the bike at 13, is still riding with friends, while the other is in a wheelchair with a stack of 10 medications.”

Wiggins lets kids try a lot of different foods at the camp, substituting a high fat mac and cheese, for instance, with a better choice from markets such as Trader Joes or Whole Foods. She sends home notes to parents about the healthier items their kids like, so moms and dads don’t spend money on products a child won’t eat. But turning other people on to her favorites has a downside.

One day she went to the store to buy turkey bacon, but after her cheerleading session with the kids about how much she loved it, and how much better she thought it was for them than its pork cousin, the store ran out. She went home that day without any turkey bacon, but pleased that the children had heeded her advice.

Wiggins not only makes exercise fun for kids, she also has a ball doing her fitness competitions. One year she performed dressed like Tina Turner; the year before she took on a spy persona. During Ms. Fitness USA, Fitness America and other competitions, she and fellow competitors are judged in categories that may include a dance routine to show off flexibility, evening gown/swimsuit to highlight their physiques, and speaking ability to demonstrate their passion for fitness.

The pediatrician has been entering contests since 2004, when she and her sister, Tamara Wiggins-Steele, saw their first fitness competition at a local hotel. “My sister challenged me to enter one,” Wiggins says. “I was inspired because she’d recently run a marathon.”

Wiggins’s diet supports her fitness goals: Her family eats grains, fruits, veggies, some chicken and plenty of fish.

In addition to her medical practice and fitness competitions, Wiggins is now actively applying for grants to help extend her fitness camps from summer to year round and market a portion-control plate, which keeps one mindful of serving sizes.

Although, it doesn’t take a doctor to tell you that you’ll probably live longer if you eat like Ms. Fitness than Miss Piggy.

by Pamela K. Johnson

The YMCA has come up with a list they call The Daily Dozen—the 12 things that can have a huge impact on a family’s health, once they’ve woven it into everyday life and routines. Getting physical helps maintain healthy weight, lowers the risk of serious health problems and helps us sleep, focus and maintain an upbeat attitude. The Y suggests that you experiment with different activities until you find some things that are fun to do, so that you’ll do them everyday.

1. Get a total of at least 60 minutes per day of fun, physical activity. Moderate activity uses large muscle groups and increases your breathing or heart rate. Ideally, you should be able to carry on a conversation throughout the exercise. If 60 minutes sounds like a lot for a busy family, don’t worry. You can spread this out in chunks of 10 to 15 minutes over the course of a day. Include outdoor activity whenever possible—it’s more refreshing and, weather permitting, sunlight can improve your mood and help your body produce Vitamin D. Remember to wear sun block.

2. Get more vigorous physical activity too, for 20 minutes, at least three times per week. This type of exercise is usually rhythmic and repetitive in nature (think biking, jogging, swimming). It uses large muscle groups and may cause sweating and hard breathing. It should increase your heart rate. Your doctor or health-and-wellbeing professional can help you figure out what heart rate is healthy and appropriate for you. Again, get outside whenever possible.

3. Bring adults and kids together in physical activities to provide opportunities for modeling positive behavior. Your kids will be more active if you are, and you can learn how to play again from your kids. Grown-ups can lead by example, showing that physical activity is a healthy, fun, necessary part of life. You can also model teamwork, sportsmanship, problem solving and flexible thinking through physical games that you plan and play together every day.

4. Limit “screen time” to less than two hours total per day. This includes television, computer time and video games. Simply put, there are only so many hours in a day. The more hours we spend in front of a screen, the fewer hours we have to take care of ourselves and each other. Decreasing screen time frees up hours for more physical activity and promotes healthier, more interactive ways for a family to entertain itself. Pediatricians recommend two hours’ maximum daily screen time for kids—and none at all for those under age two. Studies have shown that kids who rack up more screen time are more likely to be overweight, participate less in physical activity, consume more sugar-sweetened beverages and eat more. If you or your kids already top the two-hour limit, expect some resistance to change. It can be a hard habit to break. Empathize, but talk openly about why limits are important. Stay firm on the key message: in order to keep our bodies and minds healthy, we need to move more and sit less.

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5. Serve fruits and vegetables at every snack and meal. Offer fresh fruit and veggie options every day. Five or more servings per day are important for growth and development and optimal immune function. Research shows that this intake also lowers one’s risk of heart disease, stroke, high blood pressure, diabetes and certain cancers. An easy way to explain the need for variety to kids and adults is that our bodies require a rainbow of foods to be healthy: naturally red, orange, yellow, green and blue foods. A fresh, colorful diet is virtually guaranteed to be a healthy one—an idea that’s easy to wrap our minds around.

6. Make water your primary drink every day. Water is the best choice for quenching thirst. All family members need plenty of water, especially during the warmest and coldest months of the year, when the sun and indoor heating systems can dry us out. Our bodies are made mostly of water and use it to perform every function, so we have to replace it consistently. Staying hydrated is particularly important during physical activity, so take water along whenever you’re on the move.

7. Include a whole-grain or protein option with every snack. To many people, “snack” is shorthand for “simple carbohydrates,” such as potato chips. There are better options. Whole grains provide more fiber, Vitamin E and essential fatty acids. They can protect against heart disease and cancer. Higher-fiber foods can also help you feel fuller sooner, and reduce your overall food intake. Examples include almonds and tortilla or pita chips made with whole grains. Also, protein provides lasting energy.

8. Offer healthy, unsaturated-fat foods for meals and at snack time. Food labels list different kinds of fats. Both saturated and trans-fatty acids are associated with increased low-density or “lousy” cholesterol levels in the body. In contrast, foods with mono-, poly- or unsaturated fatty acids (such as nuts, fish and olives) may actually help reduce lousy cholesterol.

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9. Emphasize moderation, balance and variety. Food trends come and go, but wisdom is timeless: We all do better with balanced nutrition based on moderation, not deprivation. Moderation means eating reasonable portions whose total calorie counts don’t exceed our true caloric needs. But frankly, calorie counting often is less helpful than learning what looks and feels right. If your habit is to serve large portions, try to scale them down.

Slow down when you’re eating, savor every mouthful, and stop when you’re full—even if something tastes great. Encourage your kids to do the same. Studies show that balanced meals can help prevent cravings, increase metabolism, increase “satiety” (feeling full), assist in weight management and ensure adequate nutrition. Choose a variety of healthy foods for your family to promote consistent energy and a healthy life.

10. Provide each child with one-on-one attention every day. Carving out these times can require planning and negotiation, especially for larger families, or those in which both parents work long hours outside the home. While it’s best if this happens regularly, sometimes you can take advantage of spontaneous opportunities to spend some time with just one child. Your interests, your child’s interests, and the nature of your relationship should help shape what you do together, as well as how, where and when. Try to be flexible and creative. And, while you’re scrambling to meet everyone else’s needs, remember to take time for yourself. You can’t bring energy to your family without recharging your own batteries.

11. Sit down as a family for one meal a day. The research on this is astonishing. Studies have shown that kids who regularly eat with their parents are less likely to be overweight, smoke, abuse drugs and alcohol or experience depression. They get better grades, have stronger self-esteem and enjoy better peer relationships during adolescence. On a nutritional level, research has shown that family meals are more nutritious than “solo” meals, and that kids who eat with their family end up making healthier snack choices—eating more fruits, vegetables and whole grains. When grown-ups eat with their kids, they can set a good example by making healthy eating a lifestyle, not a temporary fix. Some experts say such role modeling may even help ward off eating disorders—a growing problem seen in increasingly younger kids.

12. Involve kids in snack and meal preparation and cleanup every day. Young kids can watch, learn and contribute as you explain what you’re doing—dicing, mixing, heating, for example. Engaging kids in safe, simple tasks will give them a sense of pride and ownership in the meal. Older kids can provide other assistance or sit nearby as they do their homework. Most kids can pour beverages, set the table or toss the salad. By teaching them these skills, you’ll be investing in a more enjoyable meal, because everyone helped. And later, their roommates and spouses will thank you!

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