Danbury Hospital Pediatric Forum Discusses Childhood Obesity: Generation XXL

By Kaaren Valenta

It is not news that America’s fast food environment — supersized portions at restaurants; palatable, inexpensive snacks at vending machines, drug stores, and gas stations — combined with a lack of exercise is creating a generation of overweight children and adolescents.

Doctors and other health providers and even the general public have come to understand that obese children are at risk of developing diabetes, atherosclerosis, and other conditions previously though as adult diseases. The question is, what to do about it.

That was the topic of a presentation by three specialists at the 19th annual Pediatrics Update Conference held recently at Danbury Hospital. Sponsored by the hospital’s Department of Pediatrics, the conference included “Childhood Obesity, the Role of Diet, Exercise, and Insulin,” presented by Elizabeth Estrada, MD, associate professor of pediatrics and pediatric endocrinology at the Connecticut Children’s Medical Center; Mickey Harpaz, PhD, nutritionist and exercise physiologist; and Gary Satou, MD, director of pediatric echocardiography at the Maria Fareri Children’s Hospital at the Westchester (NY) Medical Center.

“Four out of ten obese children become obese adolescents, and many go on to be obese adults,” Dr Estrada said.

Childhood obesity plays a role in type 2 diabetes, hypertension, hyperlipidemia, sleep apnea, asthma, irregular menstrual periods, orthopedic complications, fatty liver, gallstones, cancer, and psychosocial problems, she said.

Sometimes parents think they are providing healthy foods and beverages for their children, but there is such a thing as too much of a good thing.

“When doing an evaluation of an obese child, we often find that they consume [too many] juices, which are mainly sugar — toddlers walking around with sippy cups of juice,” she said. “Parents need to cut back on these drinks.”

Genetics may play a role in the overweight child, and there are often signs of underlying metabolic disorder if a child is not growing well, or has darkening of the skin around the neck. But even in these cases, the conditions often improve if the child loses weight and becomes more active.

“There is a direct correlation between the number of hours spent watching TV and obesity,” Dr Estrada said. “Electronic entertainment, the Internet, video games all contribute to a lack of physical activity. Parents need to limit the number of hours and turn off electronic games so that the child is bored and finds something else to do.”

Many children do not participate in competitive sports, and schools have cut back on the amount of recess for children. Many towns do not have sidewalks; urban areas have danger in the streets, she said, so parents need to create other opportunities for exercise.

“Children cannot make changes by themselves. They must have family support. Until the family is willing to make a change, we won’t succeed,” she said. “Families need to be active, avoid excess juices and soda, and not keep junk food at home.”

Dr Satou, who is a cardiologist, said physical inactivity, obesity, hypertension, and hypercholesterolemia in children and adolescents leads to heart disease in adults.

“There are 500,000 cardiovascular deaths a year in the United States, so we need to intervene early,” he said. “Elevated cholesterol, insulin resistance, less outdoor and physical activity, and increased video games and television are all risk factors.”

Children should have at least 30 minutes, and preferably 60 minutes, of physical activity daily, and less than two hours of television, he said.

“Childhood hypertension is real,” he said. “But hypertension is often asymptomatic so screening is important. Losing just five to ten pounds can reduce cardiac risk. “

Both Dr Estrada and Dr Satou said they prefer not to treat obese children with drugs because the long-term side effects are not known.

Dr Mickey Hapaz, author of The Anti Diet Book, said fluctuating blood glucose levels during the day are part of the obesity problem. Foods that are metabolized quickly, such as the simple carbohydrates found in sodas and junk food, produce an increase in insulin in the body.

“In the presence of insulin, the body cannot utilize — metabolize — fat during exercise,” he explained. “The result is increased fat storage.”

Young children may eat breakfast, lunch, and dinner, and also have a midmorning snack and a midafternoon snack, a pattern that keeps the metabolism level during the day. This pattern usually changes as the children get older, and this is when the problems start.

Without a midmorning snack, the glucose levels drop, then when the child eats lunch, the pancreas goes into overdrive producing insulin to compensate, he said. At 2 pm it drops again, until the child gets home from school and eats a snack. This produces a pyramid effect in glucose levels.

“Most American adults eat two meals a day,” Dr Hapaz said. “They spend most of the day in hypoglycemic symptoms.”

Symptoms of hypoglycemia in children and adults can be behavioral: fatigue, moody, cranky, small attention span, procrastination, or medical: headache, aches and pains, blurred vision, dizziness.

“Children and adults should eat a small meal every two to two and a half hours,” Dr Hapaz said. “That’s eating six times a day, not three, and eating the right foods, even if it is just a handful of grapes, some cutup vegetables, an apple.

“Instead, Americans eat double carbs — pasta and bread, rice and corn. There is no entrée of pasta in a restaurant in Italy. Pasta is a side dish there,” he said. “The number one problem in the American diet is sugar, not fat. Since the low-fat craze began, sugar consumption tripled in this country. One can of soda has three and a half tablespoons of sugar — tablespoons, not teaspoons.”

Dr Hapaz said skipping or delaying food, eating more simple sugars, eating larger quantities, eating double carbs, and getting less exercise all contribute to obesity. Switching to complex carbohydrates helps, but these still must be spread throughout the day, he said.

He encouraged parents to send their children to school with two snacks and to tell the school authorities that these are necessary. Parents also should advocate at school for better lunches and more exercise, he added.