Danger signs of child obesity


By Nanci Hellmich, USA TODAY

Obesity begins at home.
That's the conclusion of nutrition experts who are sorting through a parade of studies released this summer that shows children in all age groups in the USA are gaining too much weight - even babies. And those experts are laying the lion's share of the responsibility on parents, many of whom also are heavy.
Tara Todd, a registered dietitian atSt. Louis Children's Hospital, says most of her young patients have overweight mothers or fathers.

She is working with 10-year-old twin boys; they each weigh 200 pounds. Todd has tried to get them to stop drinking five 16-ounce glasses of Kool-Aid a day, and they refuse. Their mother, who also is too heavy, has begun making changes at home, but the boys won't do anything on their own.

"Kids are learning these unhealthy behaviors from an early age," Todd says. "I try to focus on the parents and get them to change what they are stocking in the pantry."

Keith Ayoob, a registered dietitian at the Albert Einstein College of Medicine in New York, says he never meets children who have better eating habits than their parents. "Parents are, hands down, the biggest influence on their kids. They need to be good role models. I heard a quote that said, 'What you say will speak to your kids. What you do will scream to them.' "

Moms and dads may want their kids to eat more fruits and vegetables, but they aren't eating enough themselves, he says.

Government data show two-thirds of U.S. adults are overweight or obese. One-third of children and teens - about 25 million kids - are overweight or on the brink of becoming so. All are at an increased risk of developing diabetes, high cholesterol and other health problems.

The prestigious Institute of Medicine is releasing a report today that evaluates the attempts being made to address what government and private experts consider a national health crisis. The food industry has come under fire for aggressively marketing high-fat, high-sugar products to kids, and schools have been criticized for selling them.

"Everyone needs to be aware that the deck is stacked against children for having a healthy weight," says Elizabeth Ward, a registered dietitian in Boston and mother of three school-age daughters. "Our society is set up to have our kids grow up overweight, which is why we need to be vigilant. The figures keep coming out, pummeling us with the fact that our kids weigh too much.

"All of us need to do something about it. When it comes to this issue, we cannot put a Band-Aid on it anymore."

The parent trap
Children say they depend on their parents for the ABCs of good health: 71% say they get information about how to be healthy from their mothers, according to a survey of 1,487 children, ages 8 to 18, conducted for the America on the Move Foundation. And Dad is the resource for 43% of the children.

But some families don't seem to know how to plan and make healthful meals, Ayoob says. "This is a generation of young parents who may have grown up on a lot of high-calorie take-out food, processed snacks and few fruits and vegetables. If they grew up that way, those are the eating habits they're going to teach their kids."

Busy parents often don't make the time to feed their children healthful foods, Ayoob says, recalling a mother who brought her preschooler in for a consultation and the boy was carrying his breakfast: a bag of Cheez Doodles and a sugary soda. The mother explained that she was running late and they didn't have time for a meal.

"We need to rearrange priorities. You can't have 'no time to feed the kids,' " Ayoob says.

The sentiment is shared by other nutritionists who encourage meal planning and limits on junk food, fast food and TV viewing.

"My philosophy is that encouraging healthy weight in kids is a family affair," Ward says. "The home environment has a tremendous influence on a child's food choices, including what he eats when away from home."

Some parents have retrained themselves and their families. About two years ago, Myrna Lisboa of Orlando noticed 5-year-old Mia was a little too chubby and considered "overweight" on growth charts. Lisboa and her husband struggle with their weight, and her husband and many of his relatives have type 2 diabetes. She didn't want her daughter to end up with the same problems.

So she attended a pilot program called Weight Watchers Family to reshape their eating habits. She stopped buying soda, ice cream and cookies and stocked up on produce. She began making more healthful recipes for dinner and insisted that her three children and her niece and nephew, who live with her, go out to play after school.

Lisboa runs her own cleaning business but cooks a healthful meal most evenings and a hot breakfast every morning with foods such as oatmeal and scrambled eggs. If her family wants a treat such as ice cream, they go out for it.

Mia's weight seems to be leveling off, but Lisboa knows the fight's not over. Her children are exposed to fattening foods wherever they go: at school, birthday parties, the mall. At least at home, she says, "I'm doing my best."

What's to be done?

Todd, who works with overweight kids in St. Louis, says her first "point of attack is beverages - always, always, always. They typically don't drink enough milk, and their diets are low in calcium."

Most are drinking a lot of soda and other sugary drinks. "I calculate the calories they get from drinks, and it's often 500 calories or more a day. Just by cutting those out, they can lose a pound a week."

Other problems: too much "grazing," too many packaged foods and fast foods, not enough fruits and vegetables, few structured meals. And some children weren't switched from whole milk to skim milk at age 2. "These may seem like small things, but they have a large impact."

Some have mothers and fathers who don't want to say "no" to them when it comes to food or TV and computer time, she says. "I worked with an overweight boy whose parents estimated he watched 10 hours of TV a day."

Ward, author of The Complete Idiot's Guide to Feeding Your Baby and Toddler, says parents have to say no more often to high-fat, low-nutrient foods. At one point, she found that her youngest daughter, then 5, was looking forward to going to the library because there was a vending machine in the basement. Ward told her daughter the vending machine was off limits.

"I have to say no all the time," she says. "As a parent, I'm the gatekeeper. The buck stops here."

Karen Miller-Kovach, chief scientific officer for Weight Watchers, believes parents give their children mixed messages about food. "They say no to everything for a day or two, and then they say no to nothing. It's better to make smaller changes and make them consistently than to change a lot of things at once and be inconsistent."

Many factors are contributing to obesity, and some children are more vulnerable than others. "It's not at all unusual to have lean and overweight kids in the same household," she says.

The good thing about making healthful changes at home is that it can help the children who have a weight problem and it doesn't hurt the others, she says. "If you have healthy food in the house, the thin child won't melt away. They'll eat more, and they'll improve their nutritional intake."

To make better meals, parents will have to plan ahead and go to the grocery store regularly to buy healthful ingredients. "When you don't plan, you'll fail," Ward says.

She knows it isn't easy. "I'm in no way minimizing how difficult it is to take the time to make meals and plan snacks. But it's worth it."

And there are plenty of good shortcuts: packaged salads, cut-up vegetables and fruit, roasted chicken, ready-to-eat fish and meat.

"Making an effort to help your child eat right is an investment in their health, now and decades down the road," Ward says.

Pediatrician Marc Jacobson, a member of the American Academy of Pediatrics' task force on obesity, believes the trend in overweight children can and will be reversed. "It's on the front of everybody's radar screen. There is a huge outpouring of commitment from schools, government, public health agencies, private industry, medical groups and parents.

"It's something we've caused," Jacobson says. "And I don't see any reason why we can't make the changes needed to reverse it."



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