Obesity
and Children
by Connie Guttersen, RD PhD,
author of the Sonoma Diet
The overweight and obesity prevalence in American children
is at epidemic levels today. In 1999, 13% of American children
ages 6 – 11 years and 14% of adolescents ages 12 –
19 were overweight. Over the past two decades, this figure
has steadily tripled.
The National Longitudinal Survey of Youth (NLSY), a nationally
representative sample also confirms these trends. This survey
is based on growth measurements of 8,270 children, ages 4
to 12 during 1986 to 1998. The results were astounding. By
1998 more than 21% of the African American and Hispanic children
as well as 12% of non-minority children were overweight. The
prevalence of overweight in non-minority children was twice
as high as what it was in 1986. This increase only appears
modest when compared with the triple digit percentage increase
in African American / Hispanic children.
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Defining Childhood
Obesity
Trends in child obesity are difficult to quantify
or compare, especially internationally, as a wide
variety of definitions of child obesity are in
use, and no common definition has been formally
established. Body mass index (wt/height2) is widely
used in the adult population, but with children
it changes substantially with age. The adult cut-off
points are a BMI of 25 kg/m2 and 30 kg/m2 for
overweight and obesity, respectively. To define
child obesity, the same principle of BMI cut-offs
are used but a percentile for the weight to height
growth reference is also used. The 85th and 90th
percentile of US BMI has recently been used as
a cut off for child overweight and obesity.
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Childhood Obesity Worldwide
The problem of overweight children and adolescents is no longer
exclusive to the United States. Similar trends are being observed
worldwide, especially in those countries and regions where
Westernized lifestyles and diets are on the rise. An increased
prevalence of overweight and obesity has been documented for
Southern Europe (Greece, Italy, Spain, and Portugal), Northern
Africa, and South America. In Japan, the frequency of obese
school children between the ages of 6 to 14 years increased
from 5 to 10% between the years of 1974 to 1993. Studies which
examined the eating habits of children and adolescents in
Portugal, Greece, Italy and Spain found that two important
characteristics of the traditional Mediterranean diet have
been lost. The first is a low consumption of saturated fat,
and the second, a high intake of complex fibrous carbohydrates.
This is due to an increased intake of dairy, sugar, cakes
and other processed snack foods. However, on a positive note,
some of the advantages of the traditional Mediterranean diet
are still present, such as a high intake of olive oil and
a greater consumption of fruits and vegetables in the everyday
diets. Snacking in between meals and the frequency of eating
fast food is much lower than what is seen in the United States.
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Obesity in childhood, particularly in adolescence, is a key
predictor for obesity in adulthood. Moreover, mortality and
morbidity in the adult population increases in individuals
who were overweight as adolescents, even if they lost the
extra weight during adulthood. It is well established that
obesity increases the risk for metabolic problems such as
cardiovascular disease, diabetes, certain cancers, osteoarthritis,
and depression related to a low self-esteem.
Focusing on the importance of healthy eating at an early
age is essential since a child’s eating habits, body
weight, and lifestyle set the precedence for one’s adult
health. Overweight adolescents have a 70% greater chance of
becoming overweight or obese as adult. This figure increases
to 80% if one or more of the parents are overweight or obese.
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What Makes a Food
Healthy?
Foods offer a wide array of nutrients, therefore
it is important to consider the variety, nutrient
density, and amounts required for growth and maintenance.
This is especially true when we consider the increased
nutrient needs of growing children and adolescents.
Eating a wide variety of fruits and vegetables
is important because different fruits and vegetables
are rich in different nutrients such as antioxidants,
phytochemicals, vitamins, minerals, and fiber.
For example, a fresh orange has 27 times more
fiber than a glass of orange juice. Many less
frequently consumed vegetables and fruits such
as blueberries, cranberries, papaya, kale, beets
and greens contain protective phytochemicals such
as carotenoids, and flavonoids. Other foods such
as spinach, kiwi, cabbage, and citrus are great
sources of vitamin C, whereas dark green leafy
vegetables, lentils, and blackeye peas are good
sources of folate. Different whole grains from
oats, wheat, and barley not only provide more
fiber, vitamin B, magnesium, and vitamin E, they
are also good sources of protein. Heirloom grains
such as farro from the Italian Tuscan region,
spelt, kamut, and quinoa also provide higher amounts
of B vitamins and protein. All of these foods
expand the selection of healthy choices in our
diets. Preparing these new foods with familiar
flavors and ingredients can mean success.
Want to explore some recipes with some of the
nutrients, fiber and grains recommended above?
Here are a few to get you started.Technicolor
Vegetable Sauté, Warm White
Bean Salad, California Ripe Olive
Rainbow Chard and Tomato Gratin, Egyptian
Lentils with Olives and Tomato, Peruvian
Quinoa Stew and Roasted Vegetable
Barley Soup.
Or, investigate these kid-friendly recipes, like
California
Pizza Pockets or Two
Birds with One Potato in Meryl's Dish. Or
send us some kid-friendly recipes of your own
and maybe you'll win the California
Olive Recipe Contest.
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Obesity and Heart Disease
The trends toward increased obesity during the past 25 years
in both children and in adults have raised concern among health
professionals, primarily for cardiovascular disease. Scientific
studies have established that cardiovascular risk factors
begin during childhood and are indeed a predictor for adult
cardiovascular disease. This concept is an extension from
a large epidemiological study of children, The Bogalusa Heart
Study. The Bogalusa Heart Study provides information on children
who have been followed from birth to 38 years of age. The
findings are generalized to the population of the United States
and have been found to be comparable to those of the National
Health and Nutrition Examination Survey (NHANES) and other
important epidemiological studies. The Bogalusa Heart Study
confirms that obesity has become an increasing problem in
the United States. The suggested explanation for this is increased
television watching and more inactivity among children. Perhaps
the single most important set of observations made in the
study are that overweight children have a set of multiple
risk factors which lead to the development of cardiovascular
disease at an earlier age during adulthood. The multiple risk
factors are referred to as syndrome X and include dyslipidemia,
hypertension, hyperinsulinemia, and insulin resistance.
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Abdominal Obesity, Syndrome X and
dietary fat
Body fat distribution, in this case, abdominal, is also
an important mediator for the development of syndrome X in
children. In addition to the set of risks contained in syndrome
X, increased levels of highly atherogenic LDL particles, fibrinogen,
plasminogen activator inhibitor 1, and C-reactive protein
are part of the metabolic syndrome associated with obesity.
Fatty streaks and raised fibrous plaque lesions were already
present in some of the young individuals. Since insulin resistance
appears to be the underlying factor that governs syndrome
X, prevention of hyperinsulinemia becomes very important in
the treatment plan. The dietary intake of children in the
Bogalusa community exceeded the total energy intake of the
recommended levels of dietary allowance at all ages. Further,
80% of children exceeded the recommendation of the American
Heart Association for total and saturated fat intake, and
some 60% exceeded the recommended dietary cholesterol intake.
Dietary intake affects the fatty acid composition of adipose
tissue; therefore modifying the sources of dietary fat can
alter the composition of adipose tissue and influence health.
A recent study published in the American Journal of Clinical
Nutrition investigated the composition of abdominal adipose
tissue in relation with dietary fat, and it’s influence
on plasma insulin and the lipid profile in an obese population
within the Mediterranean region of Spain. The study found
that oleic acid, primarily from the consumption of olive oil,
was the major component of adipose tissue and that the saturated
fat content was quite low. This finding is reflective of the
fatty acid composition of the Mediterranean diet. This population,
despite being obese and with central distribution of body
fat, had a normal plasma lipid and insulin concentration.
These findings suggest that the high monounsaturated intake
in the diet as well as its effect on the fatty acid composition
of the adipose tissue were protective against cardiovascular
disease. The study also concluded that oleic acid and omega
3 fatty acids from adipose regions where negatively correlated
with apolipoprotein b, triglycerides, and central obesity.
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 Early
Intervention is Important
The fact that this cluster of risk factors emerge during childhood,
increases the need for early intervention with proper eating
habits, nutrition, and lifestyle activity. Similar trends
have also been seen globally. Overtime, the serum cholesterol
levels of adolescents living in Greece, Spain, and Italy have
increased and today are similar to those of American adolescents.
Thus the attention placed on the various types of dietary
fat and their role in health also should be directed to what
children are eating today. The benefits of the traditional
Mediterranean diet with the intake of olive oil and olives
have been confirmed to promote health and longevity. One of
the primary benefits of olive oil is its protective effect
for cardiovascular disease and the associated risk factors.
Highlights: What Americans are
eating today.
- Less than 1/2 of the recommended amount of fruit is eaten.
The amounts eaten reflect a limited selection. Out of the
60 or more types of fruits available to us, Americans primarily
ate only 6 types. Orange juice and bananas being the most
popular.
- Americans ate the recommended amount of 4 vegetable servings
per day. However, the selection was limited in terms of
variety and nutrient dense choices. Five foods, iceberg
lettuce, French fries, potatoes prepared in other ways,
and canned tomatoes accounted for 53% of the total amount
of vegetable servings.
- The combined consumption of dark green leafy vegetables
and deep yellow vegetables accounted for less than half
of one serving per day. Similar figures were also seen for
the intake of legumes and beans.
- Americans fulfilled their grains and cereal servings by
consuming 10 servings per day. However, out of these ten
servings per day, only one was a whole grain food. The intake
centered on refined and processed snack foods, breakfast
cereals, chips, and crackers.
- Americans consumed 34 teaspoons of added sugars per day.
This is a 30% higher intake than what was previously reported
in the 1988 survey.
- Young children have decreased their consumption of milk
by 16% since 1970, increased their consumption of soda by
16%, and increased their intake of sugary fruit flavored
drinks by 280%.
- The most common sources of foods eaten away from the home
for children 5 and under were from fast food places and
day care.
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 Healthy
Habits at Meal Time
The way we eat, including the importance we place on family
meals and exposure we offer to different flavors and foods,
forms the basis of how a child relates, tastes, and accepts
different foods as they grow into adults. Many children who
grow up with healthy eating habits learn to taste, recognize
flavors, and appreciate food at a higher level. Much of this
respect for food begins in the home. It is what forms our
attitudes towards food and the memories that we treasure as
adults during holidays. Keeping the house stocked with healthy
food and snack ideas quickly improves the child's diet. The
amounts to be consumed by the child are sometimes difficult
to determine. Severe restrictions of calories for children
are not recommended. A balance between physical activity,
lifestyle habits, and nutritious foods are always your best
choices. Studies have shown that weight loss in children achieved
from diets results in a 90% failure rate. Therefore primary
prevention and gradual changes in lifestyle and eating habits
should be made. If the child has been medically diagnosed
as obese, more aggressive attempts can be done under the supervision
of a physician and dietitian. However, children appear to
regulate their food intake over time when allowed to select
their own food. Although meal-to-meal intake varies, there
appears to be little day-to-day differences in the total amount
of energy consumed at a given age.
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Why are so many children
and adolescents overweight?
Children and adolescents become overweight for
a variety of reasons. The most common reasons
are a lack of physical activity, unhealthy eating
habits, genetics, and even a combination of these
factors. Today's lifestyles of children are
much more sedentary. Television, video and computer
games all contribute to this. The average American
child spends 24 hours each week watching television.
Many of these TV hours are accompanied by high
calorie snacks. These are hours lost for physical
activity. Fewer than half of US school children
participate in daily physical education. This
is the most inactive generation in our history.
The types and amounts of food consumed by children
and adolescents have contributed to the obesity
problem. Large population studies such as the
National Health and Nutrition Examination Study
(NHANES III), the Continuing Survey of Food Intakes
by Individuals (CSFII), and the US Food Supply
Series provide valuable information regarding
what Americans are eating. In general, these studies
tell us that the amount of calories we eat each
day has increased over the last twenty years by
15%. This accounts for an additional 150- 200
calories per day. Ninety percent of this increase
comes from a higher consumption of refined grains,
sugars, and fats. The results of these studies
are often based on a 2200 calorie per day intake.
It is difficult to apply the results to a child's
eating habit since the calorie requirements are
quite different depending on the age. However,
the results of these studies signify trends of
the types of foods which are consumed by all ages.
Some of the highlights of these studies are listed
below.
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Clearly, there is a need to balance energy intake with energy
output and growth requirements. In addition, incorporating
what recent science has established for the importance of
the types of dietary fats consumed becomes an integral part
of the prescription. Monounsaturated fats can decrease the
risk of hypertension, dyslipidemia, insulin resistance, and
type II diabetes. There is a need to introduce children to
a wider variety of foods, which are good sources of monounsaturated
fats. The intake of fruits, vegetables, and whole grains are
also essential for the antioxidants, fiber, and phytochemicals
they contribute.
As food professionals, many of us have taken the endeavor
to make a difference in our nation's health by starting with
children. To not only address the foods we eat but to maintain
the joy of eating. The following is a list of healthy and
helpful suggestions to share with young children and adults.
Healthy Eating Suggestions
- Stress the importance of eating meals as a family as often
as possible.
- Encourage your child to taste and compare different basic
flavors and textures in foods. Children can experience the
wide variety of aromas and flavors found in herbs, spices,
vegetables, and fruits.
- Allow them to partake in preparation of the meals or setting
of the table.
- Involve them in the selection or purchase of foods.
- Talk to children about the origins or historical aspects
of the foods and how many foods have interesting stories
related to history or geography. (link to education program
chart.
- Take advantage of local farmer markets.
- Provide ideas for healthy snacks which are kid friendly.
- Limit the use of sugary beverages.
- Stress the importance of eating a wide variety of fruits
and vegetables.
- Do not encourage eating in front of the TV.
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