Last month, the New England Journal of Medicine published a study that projected current trends of childhood obesity in the United States into the future. The authors applied a computer simulation model to existing national data sets of childhood height and weight to predict what today’s cohort of children will weigh by the time they turn 35. The results of the study are profound, yet likely unsurprising to anyone who currently works in healthcare.
The simulation model predicted that nearly 60 percent of today’s children aged 2-19 years will be obese by the time they are 35. This is a significant increase above the current population of obese adult Americans, which hovers around 40 percent. When the authors analyzed the current population of obese children two years of age, their simulation model predicted that 75 percent of these children will still be obese at age 35.
Given the myriad individual health risks and resulting healthcare resource strain that obesity imposes, this study should not only alarm, but also hopefully motivate us as healthcare providers. As a primary care provider for children, I estimate that approximately 30 percent of the patients I see are overweight or obese. Despite what a well-recognized problem this is, we have been frustratingly slow to make any real progress in combatting the alarming trends of childhood obesity. As a whole, the problem is complex, multifactorial and overwhelming. The good news though is that there are steps providers can take to educate, motivate and empower patients and families to improve their weight and long term health outcomes.
When counseling patients and families on weight loss, I tend to focus the most on the following three issues:
- Cut out all excess calories from beverages. Just do it. All of them. Literally, all calories from drinks. Unless you’re an infant under 12 months, recovering from TMJ surgery, or a professional body builder, you should not be drinking your calories. Sneaky sources of liquid calories in children (and adults!) include: juice, tea, lemonade, soda, energy drinks, and fancy holiday-themed coffees. There still exists an urban legend amongst parents of young children that juice and tea are healthy choices for their kids. They’re not, and families need well-trained and patient medical professionals to continue to tell them so.
- Don’t be a TV zombie. Save your eyes, put down the screens and back away, slowly. Screens are ubiquitous in today’s world. Children (and adults!) cannot escape the pull of their blue-light tractor beam beaming directly into our brains. They are necessary for school, work, recreation, and socialization. The recommended screen time for school-aged children is two hours or less per day, and even two hours in front of a screen is a long time. I recommend that families limit recreational screen time to one hour or less per day; ideally on weekends.
- Move! The human body was made to move about, vigorously and frequently. As our prehistoric need to hunt and escape has become nonexistent, we have replaced all of that wonderful physical activity with… hours of motionless screen time. Despite the arguably preferable safety of modern life, people still require frequent physical activity for health and survival. This is particularly true for children, as physical activity leads to improved focus, better learning, improved behavior, better sleep, and a whole host of other benefits aside from simple weight loss. Kids (and adults!) need to get up, get moving, go outside and run, jump, skip, throw a ball, hike a trail, ride a bike, or take a walk around the block. In general, kids should get about 60 minutes of vigorous physical activity 5-6 days per week. The key to this is vigorous – good physical activity should leave you out of breath and sweaty.
As a next step for families who successfully implement the above strategies (or report no problems already doing these things), I discuss the importance of reading nutrition labels; not only for total calorie content, but also to look at amounts of protein, carbohydrates, and fats in the foods they/their children are eating. Teaching families how to read nutrition labels is another excellent health promotion strategy for healthcare providers.
For providers interested in impacting population health outside the walls of their own clinics, the problem of adult and childhood obesity is one ripe with opportunities for advocacy. Much of healthy living begins in the communities where we and our patients live, work and attend school. Developing safe play areas, reducing food deserts and improving availability and affordability of after school activities are just a few of the many steps communities can engage in to promote healthy living.
Childhood obesity in the United States is approaching epidemic proportions. As healthcare providers, we must recognize not only our ability, but our accountability, to work towards a meaningful solution.