Obesity hits kids hard, including in the Valley

Area doctors put the burden on parents to fix a national epidemic.

By WILLIAM K. ALCORN

VINDICATOR STAFF WRITER

YOUNGSTOWN — A statewide survey of third-graders found that 26.2 percent in Mahoning County are overweight.

The survey, conducted by the Ohio Department of Health in 2004-2005, also found that 20.6 percent of third-graders in Trumbull County and 25 percent in Columbiana are overweight. The state average is about 20 percent.

Kids, for the first time, are not going to live as long as their parents because of obesity and the medical problems it causes, said Dr. M. Shayesteh, a board-certified nutritionist and diabetes educator in Boardman.

If something isn’t done by the age of 40, instead of reaching the peak of their productivity, many of today’s overweight children will instead have disabling diseases, Shayesteh said.

While the cause of most children being overweight is simple — they consume more calories than their physical activity burns — the cure is extraordinarily difficult and complex, said Dr. Stephanie Dewar, a pediatrician who is division director of diagnostic referral pediatrics and pediatric residency program director at Forum Health.

“It is hard enough to get knowledgeable adults to cut back on foods that they like ... fats and sweet things. How can we expect children to do it?” said Dr. Lawrence Frisch, medical director for the Mahoning County District Board of Health. The answer, he said, is parents getting unhealthy foods “out of the house.”

Portion sizes

Adding significantly to the problem, said Dr. Shayesteh, is that portion sizes have tripled in the last decade.

Kids can consume 2,000 calories just going through the fast-food drive-thru line and ordering a burger, fries and a sugared soft drink. Then, they go home and eat more while they are watching TV, Dr. Shayesteh said.

“A significant number of children and adolescents do most of their eating at fast food restaurants. People don’t cook at home. It’s a big, big issue,” Dr. Frisch said.

When a child consumes too much sugar, blood sugar spikes. Within an hour or two, blood sugar crashes resulting in craving for more food. It is a vicious cycle, Dr. Shayesteh said.

There are even possible national security consequences of childhood obesity, which in the majority of instances leads to obese adults, the doctors said.

“Strong, physically fit people founded this country and peopled it until the middle of the 20th century, working on farms and in factories. What if we needed an army in a hurry and had to re-institute the draft; the people today couldn’t make the grade,” Dr. Frisch said.

All of the doctors say a healthy lifestyle, including appropriate amounts of healthy food and physical activity, provide the best hope for the prevention and cure for childhood obesity.

Damaging

Damage can begin at a very early age, so attention to the problem must begin also begin with young children, doctors said.

Of the 18 percent of people ages 6 through 19 in the United States who are overweight, 60 percent have one condition, such as high blood pressure, that puts them at risk for heart disease. Twenty percent have two or more cardiac risks, said Dr. Vincent W. Vanek, head of the Surgical Weight Loss Center at St. Elizabeth Health Center in Youngstown and St. Joseph Health Center in Warren.

In Ohio, 20 to 25 percent of children are 30 pounds or more overweight, said Dr. Vanek, also a professor of surgery at Northeastern Ohio Universities College of Medicine.

In addition to heart disease, doctors say being overweight as a child can lead to obstructive sleep apnea and Type-2 diabetes, previously primarily adult diseases, as well as asthma, joint problems, depression and eating disorders.

Dr. Shayesteh said 85 percent of children with Type-2 diabetes are overweight. Losing just 10 pounds can significantly improve blood pressure and cholesterol and take 40 pounds of gravity pressure off joints and the spine, he said.

One of the mistakes some doctors make is to set weight loss targets that are unnecessarily high. Losing just 10 to 15 pounds can have a huge positive effect, said Dr. Frisch, a board certified pediatrician and the John S. and Dora M. Andrews Associate Professor of Community Health Sciences at NEOUCOM.

From a health perspective, Dr. Frisch said, what really makes a difference is internal body fat that gathers around vital organs. Internal fat causes the body’s cells to develop resistance to insulin, which results in diabetes, he said.

“Children are developing internal fat at a much earlier age,” thus making them susceptible to diabetes and other health problems, Dr. Frisch said.

Emotional problems

It isn’t only medical problems that are caused and exacerbated by carrying extra pounds. Obesity in children, particularly, can lead to low self-esteem and depression, doctors said.

“Kids are so mean to each other,” said Dr. Dewar, the pediatrician.

Peer pressure is particularly tough on young people. Almost every social activity includes food, said Dr. Vanek.

Dr. Dewar developed and ran a 12-week program in 2006 in which adolescents, most ages 10-13, participated. They met as a group three times a week and participated in organized physical activity together and on their own.

The criteria for participation was weight greater than the 85th percentile BMI (body mass index) for their age group. One 10-year-old girl, who should have weighted 95 pounds, weighed 228 pounds. Nine went through the entire 12-week program. Three dropped out almost immediately, Dr. Dewar said.

“As a pediatrician, I was frustrated because I saw the results of children being overweight, and there was no organized program to help them,” Dr. Dewar said. “The thing I found, there are just so many barriers to these kids losing weight and maintaining a healthy lifestyle.”

There are not enough reasons to move, and access to exercise can be limited by distance and finances. Why can’t schools be community accessible, Dr. Dewar asked.

Study’s findings

In her program, Forum Fit Kids, Dr. Dewar discovered that 100 percent of the participants were “TV addicts,” a behavior that contributed to them not getting enough physical activity to burn off the calories they took in.

Other goals of the study were to see if the kids would pull together, identify with each other and develop friendships, Dr. Dewar said. Her conclusion was that those things occurred, and the oldest adolescent, a 17-year-old girl, became the leader “in a quiet sort of way.” In addition, all of the children lost weight, Dr. Dewar said.

The trick, Dr. Dewar said, is maintaining the weight loss, and it works best when the entire family is involved in a healthy lifestyle.

A healthy lifestyle includes eating the right foods in the right portions and getting sufficient daily physical activity, Dr. Dewar said.

For example, if a child eats sugar-coated cereal for breakfast, the blood sugar crash comes after they get to school. They cannot concentrate as well and are fatigued and easily irritated, adversely affecting their performance, Dr. Shayesteh said.

The only way to break the cycle is to not start it. Eat sugar-free cereal or toast and peanut butter or eggs for breakfast. In other words, eat more protein and less fat and sugar, Shayesteh said.

Surgery options

While eating the appropriate amount of healthy food and getting enough physical activity provide the best hope for the prevention and cure for childhood obesity, there are some limited surgical options available in drastic cases. Dr. Vanek said the two most common procedures are:

•Gastric bypass surgery, in which 95 percent of the stomach is bypassed, leaving the functional part of the stomach about the size of a little finger. It is basically not reversible. Gastric bypass should be done in centers that specialize in obesity. It is a growing trend, but it needs to be limited to those who have cardiac risk factors. It is a high-risk surgery for high-risk populations.

•LAP-band, in which an adjustable band is put around the upper port of the stomach, thereby restricting the intake of food. This, however, is not approved for people under the age of 18, and is done only in special cases.

All potential gastric bypass and LAP-band patients receive extensive counseling and psychological evaluation. It is critically important, particularly with the younger population, that patients and their parents understand what they are getting into, Dr. Vanek said.

With either procedure, patients must still change their eating and exercise habits, Dr. Vanek said.

The local doctors say the health care community is not overreacting to the childhood obesity issue. “On the contrary. We are under-reacting. The World Health Organization has said obesity is the world’s biggest problem. This a group whose previous focus was on not enough food,” Dr. Vanek said.

From a public health perspective, childhood obesity is “catastrophic. Obesity could shorten the life span of an entire generation by five years,” said Dr. Frisch.