A Weighty Issue

Healthy behaviors can counter childhood obesity

Ana Hernandez, 32, of Cicero, was worried about her son, Luis, who is now 9 years old. For years, his diet was heavy in junk food, he was gaining a lot of weight and he was always tired. Her pediatrician referred them to a pediatric weight management program.

After just two months of the program, Luis was a different kid. He dropped clothing sizes (from an 18 to a 14), swapped snacks from cheese fries to apples and is much more active. Best of all? He feels like a new kid.

“I used to be the last one in karate — I used to run slow,” says Luis, who is in third grade. “Now I’m playing tag and doing sports and eating healthy. I can run faster than other people. I feel happy that I’m starting to lose weight.”

Weight gain

About 1 in 6 kids is considered obese, according to the Centers for Disease Control and Prevention (CDC). There are a variety of reasons at play, says Jami Josefson, MD, MS, a pediatric endocrinologist at Ann & Robert H. Lurie Children’s Hospital of Chicago and an assistant professor at Northwestern University’s Feinberg School of Medicine.

“One main [reason] is the availability of cheap food that is high in fat and low in nutrition,” she says. From fast food restaurants to convenience stores to their own kitchens, kids are surrounded by high-calorie foods that may satisfy an initial craving but don’t keep them full.

In addition to consuming more calories than their bodies need, today’s kids are expending fewer calories than they used to. “With TVs and phones and iPads, kids are spending more time on screens and less time moving their body, whether that’s playing outside or doing sports,” Josefson says.

Too many calories in and not enough calories out equals weight gain. It seems simple enough, but it’s actually more complex than that. Josefson is studying how the family unit affects the development of obesity, and how factors in pregnancy and birth can affect a child’s weight as they get older.

I used to be the last one in karate — I used to run slow. Now I’m playing tag and doing sports and eating healthy. I can run faster than other people. I feel happy that I’m starting to lose weight.”

“Obesity is occurring in all ages, including women of reproductive age,” Josefson says. “Gaining excess weight during pregnancy puts the mother at higher risk of developing gestational diabetes, and being born very large is linked to childhood obesity.”

In addition to possible delivery complications, larger babies are more likely to keep gaining weight at an excessive rate. Josefson’s research involves how a baby’s body composition at birth — i.e. how much fat the baby has versus fat-free mass — affects his or her weight and body composition through infancy and early childhood. “We’re particularly interested in how the amount of fat tissue at birth is associated with outcomes in childhood,” she says.

Heavier newborns may be more likely to store body fat than normal-weight newborns, which may interfere with glucose regulation and the appetite regulation systems of the brain, in turn setting kids up to get even heavier throughout childhood and into adulthood.

“It’s so difficult to reverse that trajectory of continued weight gain,” Josefson says. “That’s why it’s so urgent to study the factors in pregnancy and in infant and toddler years that may be causative in childhood obesity.” Josefson is also conducting research with nearly 300 women who are overweight and obese to determine whether healthy lifestyle interventions during pregnancy have an effect on the health of their children three to five years later.

Adult-sized health issues

Kids who are overweight and obese face the same health problems as overweight adults, says Mary Crisostomo, MSN, APN, a Loyola Medicine pediatric nurse practitioner who specializes in childhood obesity.

“When you have too many of any kind of cell in your body, including fat cells, it starts causing damage,” Crisostomo says. “These kids can have signs of fatty liver disease, high cholesterol, high blood pressure, a higher risk of developing a heart attack or stroke, diabetes, joint problems and depression. These are health problems we see in elderly populations — not something that kids should have.” These health issues mean that for the first time, kids’ lifespans may be shorter than those of their parents.

Kids who are overweight are more likely to be bullied and have self-esteem and self-confidence problems, which can affect academic performance. “It’s not just about your organs on the insides of your body, but your ability to learn,” Crisostomo adds.

That’s another reason why intervening to help overweight kids, before they grow into overweight adults, makes sense. Educating kids and teens is the goal behind the Adolescent and Pediatric Weight Management Program at UI Health, which is designed to help overweight kids not only lose weight, but also lead healthier lifestyles.

A one-size-fits-all approach isn’t the answer, says Karen S. Bernstein, MD, MPH, director of the Division of Adolescent Medicine at the University of Illinois at Chicago, who works with kids in the program.

Participants range from age 12 to 22 and are typically obese, with a BMI of about 40. At the first visit, their weight-loss options, including bariatric surgery, are discussed.

The program uses a motivational-based approach, where each patient’s readiness to change is assessed, and then goals, barriers and accountability are addressed.

“It’s very collaborative — the patient makes the rules,” Bernstein says. “It’s determining how ready they are to change, what barriers are in place and how we can remove those barriers and help motivate them to make those changes.”

For kids who need a more intense intervention, there is also an eight-week class that combines diet modification, increased physical activity, stress reduction strategies and behavioral parent training to build healthy living habits that will contribute to weight loss. Kids do things like measure fats and sugars in common snacks, participate in a family nutrition scavenger hunt at a local food store and develop skits to demonstrate healthy and unhealthy eating habits.

Modeling healthy behaviors

Weight management programs help kids make better lifestyle choices, but the most effective weight loss interventions start at home, says Sarah Calamita, RD, a dietitian at the East Bank Club.

An easy way to get kids thinking about eating healthy is to involve them in shopping, preparing and cooking meals. “Get a cookbook and say, ‘Let’s look at this cookbook and find something healthy we can cook together,’” Calamita says. “Or say, ‘Let’s pick out something you’ve never tried before, and we can do a little bit of research on it to see why it’s good for us to eat.’”

Note that kids’ taste buds change, and it may take trying a food seven to 15 times before they decide they like it. If your child says she doesn’t like something, don’t give up — prepare or cook it in a different way.

“If you give a kid carrot sticks and he dislikes them, try them in a different form,” Calamita says. “Use a wavy knife; cut them in cubes; cut them in coins; bake them and mash them; or make carrot French fries.” Roasting, grilling or sautéing vegetables lends them different flavors, as does experimenting with spices.

Limit the amount of junk food you bring home, and avoid processed food — the stuff in cans and packages — as much as you can. To keep kids from snacking frequently, “stick to strict meal and snack times — don’t let kids eat whenever and wherever they want,” Calamita says.

Get rid of distractions (no cell phones at the table!) and sit down to have meals together as a family as often as possible. Consider using smaller plates, bowls and glasses or even divided plates to control portion sizes and help kids learn how to “eyeball” their own servings so they learn how much food they need. “If you give them a chance, kids are good at knowing when they’re full,” Calamita says. “You want them to learn to listen to their internal cues.”

The bottom line is that parents have to act as role models for their kids to set them up for healthier childhoods — and adulthoods as well.

“I didn’t want Luis to have diabetes,” Hernandez says. “I knew I needed to [help him lose weight] before it was too late. It’s not our kids’ fault — it’s what we’re feeding them. It’s our fault as parents if we don’t do something.”