The childhood obesity octopus is out to ruin our children’s future! What can we do to stop it?

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Artwork by: Sierra B.
©2010 Littlestomaks.com

I am so excited to learn that the US Congress has officially proclaimed the month of September 2010 as the first ever National Childhood Obesity Awareness Month! Here is Rep. Marcia Fudge making a statement about this legislation:

There is no doubt anymore that childhood obesity is a serious problem. First Lady Michelle Obama brought the much needed high profile attention to this issue early this year when she launched her Let’s Move campaign. I am not going to repeat the awful statistics any more, but the following statement from this video should be an eye opener to everyone, even if their kids are not overweight or obese:

…unless we work to reverse this epidemic, these 23 million kids will be in danger of never being grand parents. Imagine. Living a life you know you may never live long enough to be a grandparent.

Childhood obesity is an equal opportunity health issue which threatens the future potential of our children. That is why we must address childhood obesity NOW. The month of September 2010 offers us an opportunity to make a difference. This childhood obesity awareness month toolkit offers several ways you can help.

I will be focusing on this topic on this blog throughout the month of September. It also happens to be the month I was born, so I am super excited about it!

Join me in this journey through your comments, opinions and suggestions. I look forward to hearing from you.

©2010 Littlestomaks.com

Childhood obesity and overweight is becoming a major issue today. If you are facing this situation with your child, you have got to understand the notion of resting metabolic rate (RMR) and how it can help you manage your child’s weight.

I first learned about RMR from Milton Stokes, who is a registered dietitian and an expert in weight management issues. He told me that a test is now available for measuring RMR and it may even be covered by your health insurance. I was so intrigued by it that I asked him to connect me with an expert on the science behind RMR and this new measurement technique so I could share a detailed article with you. Check it out and let me know if you have any questions. I will post a follow up article to get your questions answered.

Question: What is Resting Metabolic Rate (RMR) and how does it relate to weight gain?

Scott: Weight management is a simple, yet often difficult, task of balancing energy (i.e., calories) intake with expenditure. Individuals will gain weight when they consume more calories then what they typically burn. The opposite is true for weight loss; burn more calories then calories consumed. In order to determine appropriate energy balance an individual needs to know how many calories they burn each day. Total energy expenditure (TEE) is comprised of resting metabolic rate (RMR), activities of daily living, and the thermic effect of food (TEF). RMR is the main metabolic factor and represents between 60 to 75% of TEE while TEF is approximately 5-10% of TEE [1, 2]. Essentially, the higher the RMR higher is the TEE unless you are more active then the usual individual.

Question: How does this apply to young children?

Scott: Weight gain in children is a topic of great concern. The prevalence of overweight children is 15.5% for 12 to 19-year-olds, 15.3% 6 to 11 year-olds, and 10.4% among 2 to5 year-olds. Overweight has increased five percentage points among 12 through 19 year-olds from 10.5% to 15.5% in approximately 10 years [3]. Unfortunately, future projections indicate children that become overweight as children are at substantial risk of becoming obese later in life.

The children in the U.S. lead a very sedentary lifestyle. With the advent of video games, decreased physical activity in schools, and other social pressures children are not burning a lot of calories throughout the day. In-comparison, studies have indicated that they are consuming large amounts of calories. Therefore, they are in a positive energy balance (i.e., consume more calories then what is being burned). It is not so much a question of a slow metabolism but more of an issue with lack of activity.

This being said, parents should consider having their child’s RMR and activity level measured to best determine TEE. This will help a clinician tailor a nutrition plan to meet the weight management needs of the child.

Question: What determines a child’s RMR? Is it genetic or are there environmental factors?

Scott: RMR is regulated by a complex biochemical and central nervous system. Recent advancements in the Human Genome Project have led to a better understanding of genetic influences in several disease and metabolic states. The mitochondrial uncoupling protein 2 (UCP2) gene has been linked to obesity by way of possible influence on RMR [4-6].

However, it is estimated that this specific genetic influence may only account for the about 5 % of the variance in RMR.

Other biochemical influences may be related to specific hormones (i.e., Testosterone, Leptin). Much is known about the role testosterone has on the human body by way of muscle tissue generation. However, new research has indicated Leptin influences energy metabolism as-well. Leptin is typically known for its regulation of appetite and hunger.

Individuals that are leptin-deficient are often obese and have a lower RMR then normal weight individuals [7].

Still to this day, fat-free body weight is the main contributing factor on RMR. Studies have routinely indicated fat-free bodyweight predicts 80% of an individual’s RMR. Therefore, having more muscle weight in-comparison to fat weight will result in a higher RMR.

Question: Is there a relationship between autism, asthma, food allergy or other health conditions and RMR?

Scott: RMR does change with various health conditions. Most of the time, when an individual is hospitalized for an acute illness their RMR increases. The main reason why RMR increases is the body is trying to repair itself. This is a common reason why individuals typically lose weight when they are in the hospital. In addition, medications for several psychological (depression, schizophrenia, etc.) and physiological diseases (hypertension, diabetes, etc.) have shown to slow RMR [8-11]. However, some medications may not alter RMR but have an effect on overall TEE.

A study conducted in 1999, indicated medications prescribed for children with attention-deficit/hyperactivity disorder had no effect on RMR. However, the medication did result in decreased physical activity by 16-20% [12].
Since there are many disease states and medications that can affect RMR it is important to monitor RMR during medical management of given condition. Since RMR usually changes with a 5-10% weight change it is recommended, that patients receive a RMR measurement so clinicians can prescribe the most accurate nutrition program to best manage bodyweight.

Question: Where can I get my child’s RMR measured?

Scott: Measuring RMR is still fairly new. However, technology has made measurement of RMR easier and more applicable to general wellness facilities and out-patient medical clinics. You can search for health and wellness professionals online at Microlife Medical Home Solutions . The cost for a metabolic test is approximately $50-75 depending on location. In addition, insurance companies may cover this measurement if your child is overweight and/or has an underlying medical issue that has caused abnormal weight gain.

References:

1. Segal, K.R., E. Presta, and B. Gutin, Thermic effect of food during graded exercise in normal weight and obese men. Am J Clin Nutr, 1984. 40(5): p. 995-1000.
2. Danforth, E., Jr., Dietary-induced thermogenesis: control of energy expenditure. Life Sci, 1981. 28(15-16): p. 1821-7.
3. Ogden, C.L., et al., Mean body weight, height, and body mass index, United States 1960-2002. Advance Data from Vital and Health Statistics, 2004(347): p. 1-17.
4. Yanovski, J.A., et al., Associations between uncoupling protein 2, body composition, and resting energy expenditure in lean and obese African American, white, and Asian children. Am J Clin Nutr, 2000. 71(6): p. 1405-1420.
5. Bouchard, C., et al., Linkage between markers in the vicinity of the uncoupling protein 2 gene and resting metabolic rate in humans. Hum. Mol. Genet., 1997. 6(11): p. 1887-1889.
6. Walder, K., et al., Association between uncoupling protein polymorphisms (UCP2-UCP3) and energy metabolism/obesity in Pima indians. Hum. Mol. Genet., 1998. 7(9): p. 1431-1435.
7. Klok, M.D., S. Jakobsdottir, and M.L. Drent, The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obes Rev, 2007. 8(1): p. 21-34.
8. Dickerson, R.N. and L. Roth-Yousey, Medication Effects on Metabolic Rate: A Systematic Review (Part 1). J Am Diet Assoc, 2005. 105(5): p. 835-843.
9. Dickerson, R.N. and L. Roth-Yousey, Medication Effects on Metabolic Rate: A Systematic Review (Part 2). J Am Diet Assoc,, 2005. 105(6): p. 1002-1009.
10. Procyshyn, R.M., A. Chau, and G. Tse, Clozapine’s effects on body weight and resting metabolic rate: a case series. Schizophr Res., 2004. 66(2-3): p. 159-162.
11. Fernstrom, M.H., et al., Resting metabolic rate is reduced in patients treated with antidepressants. Biol Psychiatry, 1985. 20(6): p. 692-695.
12. Butte, N.F., et al., Stimulant medications decrease energy expenditure and physical activity in children with attention-deficit/hyperactivity disorder. J Pediatr, 1999. 135(2): p. 203-207.

©2010 Littlestomaks.com

Disclaimer – Information provided in this article should not be considered as medical advice. Consult with your physician if you think your child needs an RMR test and how it can be used to control and/or reverse weight gain. I have no business relationship with Microlife Medical Home Solutions, Inc., and this article is not an endorsement of their products and services.

Greetings!This week is the World Breastfeeding Week. Organized by the World Alliance for Breastfeeding Action (WABA), the focus this year is In Emergencies, Breastfeeding is a Lifeline. I never thought about breastfeeding this way, but it makes sense. Children and infants are most vulnerable during a catastrophic emergency – whether natural or man-made. According to WABA estimates, child mortality can be 2 to 70 times higher than normal under these conditions due to diarrhea, malnutrition and respiratory illness. They believe that by supporting breastfeeding in non-emergency situations, we can be better prepared to save the lives of young children during emergencies. Here is a great post by my blogger friend Annie on this subject by Annie on PhdInParenting.

Here again are 5 interesting nutrition stories of the week that caught my eye. Enjoy and drop a comment to let me know what’s on your mind.

Millions of kids vitamin D deficient – here we go again!

It seems like our appetite for reporting vitamin D deficiency in kids is insatiable! In yet another study published recently in Pediatrics, researchers report an alarming prevalence of vitamin D deficiency in kids 1-21 years old. They find that 9% (about 7.6 million) children are deficient and 61% (about 50.8 million) have insufficient levels of 25-hydroxyvitamin D. This news got a lot of coverage this week, mainly because the numbers seem so high. Also, in the same article, these researchers highlight a link between low levels of vitamin D and increased risk of cardiovascular disease. This sounds really scary, and no doubt, makes a perfect headline for an attention-grabbing story.

I have a few problems with these types of studies. First, they rely mainly on the level of 25-hydroxyvitamin D in blood. There is no consensus among experts when it comes to estimating deficiency or insufficiency in children. Second, the biochemistry and processing of vitamin D is very complex, something I don’t claim to understand at all. But I am certain of this – it cannot be as simple as just the blood level of 25-hydroxyvitamin D which relates to cardiovascular health or bone density. But the real reason why I get frustrated is that these studies do not answer the “so what?” question a parent might be concerned about. Drink milk and vitamin D fortified OJ, let your kids out to play, not watch too much TV – well, that is old advice and should be followed with our without such sensational news.  Should you ask your pediatrician for a 25-hydroxyvitamin D test? Should you take supplements? There is no real, practical and actionable advice from these “experts”.

My 2 cents – when you hear this type of news, take a deep breath and don’t panic. Take a quick look at what your child is getting on average – milk, OJ, cereals, fish, eggs, cod liver oil etc. How much outdoor activity in the sun he gets on average. Take a long term view on this but continue to watch the diet and activity level regularly. If you still have doubts, ask your pediatrician if a supplement is needed.

No one wants to hang out with overweight kids

Why are overweight kids so picked on? A very interesting post from Dr Joanna Dolgoff – one of our Ask the Expert contributors – provides some insight. Appears that kids have more sympathy for children with handicaps, and would rather be friends with them, than hang out with overweight or aggressive kids. Deep down, overweight kids are blamed for their condition. They should be able to change it by losing weight is a common belief. I wrote about this in my post on childhood obesity because this kind of negativity leads to low self-esteem and a downward spiral of physical and emotional health problems among overweight and obese kids. Stereotypes about obesity form early in life it seems.

FDA and USDA get a budget of $125 billion

That is a giant number! Extra funding is supposed to go for improving food safety and farm subsidies. What surprised me though is the estimate that almost half of the budget for the two agencies is set aside for food stamps and Government nutrition programs. What kind of a return on investment can we expect from this level of spending? I find it ironical that on one hand we spend extra on healthcare in managing obesity-related diseases, while on the other, we have to also budget a huge amount fighting hunger and poverty. These two problems are two sides of the same coin in my opinion, but I do not yet see a comprehensive policy (and budget) to address them. We know that there is poor communication and cooperation between different Government agencies – the right hand does not know what the left is doing, but both want to get bigger and fatter and demand more funding! And as far as food safety is concerned, the approach is to focus on compliance rather than prevention. This smells of more bureaucracy to me!

So many cooking shows, so little cooking

Michale Pollan wrote a very good – although very long – article in the New York Times magazine this week. Out of the Kitchen, Onto the Couch takes us through the history of cooking shows starting with Julia Child to the likes of present day Iron Chef and Rachel Ray. We watch the Prime Time food network for entertainment value these days, not to learn anything about cooking the food ourselves! Pollan makes two great points – one, that the food industry along with the Television has been quite successful in taking over the “cooking” part from us by providing us with relatively cheap, readily available, packaged nutrition (poor nutrition I must admit). And second, that we are now quite comfortable ordering fancy items at restaurants and our appetite and desire for an ever increasing array of foods seem never ending. The less we cook, the more we eat and the more weight we put on. So how can we get back to cooking? We don’t have time for cooking, but we have time to watch a cooking show. Seems to me it is a matter of priority and attitude. I think we need to invoke Nike’s Just Do It! for preparing our own food. Not necessarily from scratch, as a lot of purists might want you to, but enough so that you can control what goes inside your body.

Check out this cookbook review and giveaway

Here is a shout out for my blogger friend Jenna of Kidappeal. She has done a great review of Vegetables Get the Royal Treatment by Jill Nussinow (aka The Veggie Queen!), and she is giving away a copy of this book to one lucky winner selected from the comments on the post. It is very simple to enter – all you need to do is to leave a comment about your favorite vegetable and your favorite ways to prepare and eat it. Check it out, the contest ends on August 16th.

Enjoy your weekend! And let me know what you think.

Photo source -Raphael Goetter on Flickr via everystockphoto
©2009 Littlestomaks.com

Do you find yourself wondering if your child is growing “normally”? Do you find yourself comparing your child’s height or weight with other children when you take her out to play in the park? Do you begin to make plans about how you will change her diet when your doctor informs you that she is below 50th percentile in weight for her age?

If so, you are not alone. It is a natural instinct for any parent to worry about the growth of their child. In my post on Take a Step on the MyPyramid for Preschoolers, I introduced you to how you could make a growth chart for your toddler based on his height and weight. In this post, I provide you more details and suggest a few actions for you to consider as you think about your child’s growth.

Growth charts are based on national population statistics

Data on physical measurements (weight, head circumference, length, standing height etc.) for children of different ages is collected from national surveys and analyzed using statistical methods to prepare the growth charts. These charts show lines for various percentiles, which are used as a reference for comparing the actual measurements. There are two limitations of this method that you should be aware of:

1. Just like the census, national health surveys are not done every year. In fact, the last National Health and Nutritional Examination Survey (NHANES III) was done during 1988 – 1994. This led to a revision of the 1977 growth charts in the year 2000. Amazing, isn’t it, that today’s growth charts are based on data that is 15 years old! Surely, a lot has changed since then.
2. Data is collected based on a “statistical sample”, which is supposed to represent the true nature of the whole population. Although there are some rules for estimating this “statistical sample”, no one can say with 100% confidence that it really represents everybody. In the interest of creating a “normal” growth profile, the researchers have to make some trade-offs and not include various special cases. It is important for you to be aware of what those special cases are. Your pediatrician should be able to advise you if you happen to be one of them.

Having said that, the current growth charts are still a very useful tool to evaluate the general growth pattern your child in relation  to what is normally expected. Recognize that the researchers do a very good job planning for a national survey to really “fill the gaps” in their current data and understanding. For example, in the NHANES III, they over-sampled infants and toddlers 2 months – 5 years old to properly account for the growth patterns in this age group. They also included a higher number of breastfed children to reflect the rising rates of breastfeeding compared to previous years. They utilized advanced statistical methods to create a better and smooth transition between infants/pre-schoolers and adolescents.

Growth charts are age and sex specific

Different measurements are made on infants (less than 36 months) and toddlers/adolescents (2 – 20 years). For infants, weight, head circumference and head-to-toe height is measured in a lying down position. The measured data is evaluated on these 4 types of growth charts:

1. Length for age
2. Weight for age
3. Head circumference for age
4. Weight for length

In most cases your pediatrician will show you the first two charts; usually blue for a boy and pink for a girl.

For toddlers/adolescents, weight and height is measured in a standing position. The measured data is evaluated on these 3 types of growth charts:

1. Weight for age
2. Stature (height) for age
3. BMI (Body Mass Index) for age

Again, your pediatrician will most likely show you the first two charts. However, the BMI for age is the most important chart in my opinion (see below)

Growth charts do not apply to preemies and other special cases

Data from very low birth weight (VLBW) is  not included in the infant growth charts since their growth patterns are known to be very different from higher weight, full-term infants. If this applies to you, there are other specialized growth rate charts you can ask your pediatrician about. The best general growth charts in this case are based on the the Infant Health and Development Program (IHDP) data, which can be used from 40 weeks to 36 months. It is not, however, without its limitations; so you should have a good discussion with your doctor.

Other special cases include health conditions such as Down syndrome, cerebral palsy and Turner syndrome. Special growth charts are available but again, they have many limitations.

Although, I did not find any discussion on the topic of multiples (twins, triplets etc.) I think that these too are special cases. Usually, multiples have low birth weight and do not go to full-term. Even though, the NHANES III data included low birth weight infants, I did not find any reference of categorizing data for multiples. Multiples may also show different growth patterns, where one of the child grows “normally” but the other(s) lag behind. It is my (selfish) hope that the next national survey will try to account for this gap.

Pay special attention to the BMI for age growth chart

Body Mass Index (BMI) is calculated using both weight and height. It is very easy, and you can use this online calculator simply by entering the age, weight and height. BMI is known to track very well with age, first increasing from birth to 8 months of age, then falling until age 6 and finally rising with age. There are two important things you can learn from the BMI chart with age for your child -

1. Percentile – Your child is at high risk of being overweight if the BMI is between 85th and 95th percentile for his age. If the BMI is over 95th percentile, then the child is considered overweight.
2. Trend in BMI for age chart – the sooner your child’s BMI hits its lowest number, the more likely he  is going to have a higher BMI percentile when he grows up, and greater is his risk of being overweight. Watch the trend in BMI for age over time closely and take action sooner than later.

BMI-for-age chart, Boys, >2 years old

Growth charts are used only as a screening tool

It is important to understand that growth charts are used only as a screening tool and not to diagnose a medical condition. The 5th percentile cut-off is useful to identify infants at risk of overall health and growth problems. The 95th percentile cut-off, especially on the BMI for age chart, is useful for early identification of childhood obesity. However, resist the instinct to be alarmed by a single point on these charts. You should look at a series of points over several visits to understand the overall pattern and assess if there is any unexpected change. If you have a concern, consider making these charts more frequently. With online tools, you don’t have to wait for your next doctor visit.

Take action

Here are 5 actions you can take:

1. Use information to manage your concerns and anxiety over what is a “normal” growth pattern for your child. Hopefully, this article is helpful; however there are a few more resources you can use to learn more about growth charts:
   • CDC’s growth chart website
   • Use and interpretation of growth charts – an instructional guide
   • Recommendations for growth references for VLBW infants
2. Resist the urge to make nutritional changes or goals based on a single data point on a growth chart.
3. If a single data point causes concern, track more often and then make a plan in consultation with your pediatrician.
4. Resist the urge to compare your child with others, or even with his own brothers/sisters. For example, two children with the same BMI could have very different risks based on their age.
5. Take a long term view to your child’s growth.

Feel free to share your personal experience and advice regarding growth charts.

There is a certain perception, especially outside the US, that Americans are fat and lazy. Even our own media bombards us with stories of poor eating habits (think cheeseburgers and fries) and inactive lifestyle (think couch potatoes). Then there are alarming statistics on rising rates of obesity, diabetes and heart disease. And you really begin to pay attention, and raise the volume on the TV, if the story is focused on weight problems in children. After all, who would want their children to grow up in poor health?

But is it really that bad? Is it simply an American issue?

Check this out..

This came from a report issued by the WHO Regional Office for Europe following a November 2006 Ministerial Conference held in Istanbul, Turkey.

What’s wrong with this picture? Our media shows us images of slim, healthy-looking Europeans biking to work, eating healthy-looking food and living a stress-free life. On the other hand, the Americans are shown eating junk food, driving to work in gas-guzzling SUV’s and living a hectic stressed-out life. And all this is supported by “facts” and “numbers” with fancy charts and interviews with “experts”.

Now, let us not stop there…here is another interesting fact:

I don’t have anything against the Europeans or the Aussies. In fact, I have many good (and very healthy) friends from both of these continents. And before you get the urge to say that “you got your head in the sand“, let me say that we do need to pay attention to the numbers and make smart nutrition choices for ourselves and our children. After all, that is why I am writing this blog!

As a parent, it is natural to be concerned. Concern leads to caring; caring leads to action; and action leads to results. All I am trying to say is that it is not useful to be alarmed by the so called news in the mainstream media. In this age of short attention spans and low ratings, the media needs a big horn to get the message across. It is up to us to filter the noise, take a deep breath, and look at the data in a calm manner so we can make our own decisions.

It is my intention to help you do exactly that through this blog. Let me know how I am doing.