Obesity in children is a national epidemic. Duh?! AND, it seems that this is so because the nation’s doctors are not counseling the families of overweight kids about their lifestyle and dietary choices! Another hype piece from US News and World Report. This is simply the last straw.
I am going to weigh in on the subject.
At least 30% of the children I see are obese. And these kids are not just husky or chubby, but morbidly obese in some cases. My population is skewed because a few of the problems I treat, such as sleep apnea and extra-esophageal reflux disease (acid and other nasty stomach contents coming up into the throat, mouth, sinuses and lungs) are much more common in obese children. Usually their pediatrician has discussed their weight problem to some degree. The parents are aware. They have been given resources. Many have been “referred to specialists.”
As part of my consultation I spend a lot of time collecting information about their diet and eating habits (if you go to that link, scroll down), which I review with them in detail. I given them simple rules to follow that don’t take away all their treats–we call them weight reduction strategies. We talk exercise and activity. Our success rate is poor, like most others.
Here are my thoughts on why today’s kids are fat:
- Subsidized school meals–children eat both breakfast and lunch at school. Neither their food choices nor their portions are monitored. The foods they are offered are rich in calories and carbohydrates. One child told me he had two bowls of a sugary cereal and a muffin everyday for breakfast. He just ate his daily allowance for empty calories.
- Uneducated parents–most do not understand the difference between a carbohydrate and a protein. Use the words “processed foods” and you are likely to get a blank stare (I have substituted the words “food in a box”). If you don’t understand what is going to put on the pounds, how can you change what the family eats? And in almost all cases, this is a family problem. Look at one or both parents and you will see why.
- Lack of imagination–exercise is no longer thought of as something a kids just does. It is thought of as a planned activity, so if there is no “gym membership,” how can they exercise. Many families own treadmills or stationary bicycles and don’t think to have the child use it. Exercising with one of the free TV shows is not considered. Twice a week gym class, if they have gym at all, is considered sufficient. I suggest: Taking a good walk? Running up and down the stairs in the house? Cleaning their room? Mowing the lawn? Raking leaves? Again, blank stares. What do kids do all day?
- Lifestyle–sedentary lifestyles with emphasis on electronics have not helped. Eating erratically and late at night. Make several trips to fast food chains every week. It is not uncommon that we will finish a consultation and the family will be heading out for a “treat” because the child had to endure seeing the doctor. Most common: Tim Horton’s Donuts or McDonalds. It drives me crazy!
- Portion control–plates are bigger, cups are bigger, portions are bigger. And seconds are the de riguer.
And, by the way, obesity is not just a problem for the poor. It is alive and well in not so poor people. The argument that poor people cannot find fruits and vegetables to eat because of the local groceries being poorly stocked is out of touch with the realities of where people go to eat, what they eat, and how they eat. Cooking and eating at home is just not done. (In the nurses lounge while I was having lunch, a cooking show was on that highlighted how to cook healthy and inexpensively? A fish dinner with vegetables for 4 was at $2.28/person–Mahi-mahi–took 15 minutes to prepare).
Laziness? Lack of education? Poor choices for what and where kids eat? These are the real reasons kids are obese. We doctors get 20-30 minutes with a patient and family once or twice a year. It’s ridiculous to think we have the magic bullet to curb their appetites.
Blaming doctors is another way of avoiding solving this problem. Time to find another scapegoat. Maybe a good look in the mirror and the elimination of the enablers would be a better headline for the real story.
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3 Comments
You are so right on this. Fortunately, my son was always very active and slim despite genetic issues that could have easily made that unlikely.
It is not just pediatricians. It took several years, a laundry list of physicians, and a Major Diagnosis to have “I am fat and exhausted” to have hypothyroid and other issues diagnosed. Even with clear diagnostic results in hand, my issues were dismissed as “menopause,” laziness, and unreasonable expectations.
It was almost worth the Major Diagnosis to be heard and get guidance on lifestyle changes possible and useful around the general health issues. Every woman I know with the same Major Diagnosis is in better general health and fitter than before.
Heaven help those who are exhausted, fat, and not badgering their health care providers. Fat is a life and death issue and deserves much more intelligent attention.
Nice post. Not sure how, or if, we (society) is going to solve the ever increasing problem of obesity in our country. I am convinced that this epidemic will a major detrimental impact on put economy going forward. 15% of our GDP goes to health care expenses. This will no doubt increase with the increase in the chronic illness that most of our dollars go to treat. Furthermore our workforce productively will decrease with the increasing size of our waistlines. Employers will refuse to offer employment to an obese workforce. A hospital in Texas has decided not to hire physicians and healthcare workers with a BMI greater than 35. Other employers will follow suit. No matter how healthcare is paid for in the future we will be unable to afford it. We need a major paradigm shift in our thinking about food.
We also need to concentrate much more on PE programs in the schools. Only one out of six schools in this country require PE. Of those a good percentage probably don’t even require changing into gym clothes. Kids don’t want to sweat.
I do not believe our free market is going to fix this as Romney believes. The free market is the cause of this catastrophe.
Visit my blog from time to time. I’m very interested in this issue.
Keep up the good work. You are at the forefront with your otolaryngology practice. We certainly are not to blame. Society and a free market does not support a healthy lifestyle. There is no profit in it.
Ira Schwalb, MD
Anesthesiologist
St. Joseph’s Medical Center
Stockton, CA
Thanks for the comments Ira and Doris!
I don’t think this is a healthcare issue. Yes, physicians deal with the consequences, but the agricultural-industrial complex, government regulations, cultural acceptance of new “norms” and the idea that someone else besides parents are responsible to feed their children are intertwined in a very difficult dynamic that will not have an easy solution.
I have to disagree about a health lifestyle and profit. There is a huge industry around this. The bandwidth of acceptability in appearance, behavior, speech, values and the like has become so wide that we have lost all sense of proportion.