By Elaine Porterfield
Kids are packing on the pounds, with serious health consequences. But doctors are beginning to learn what really works to help them slim down.
Tanya Wanchena of Auburn knew her youngest daughter Makenzie, 13, was overweight. But she was still shocked when insulin levels ordered by Group Health pediatrician Pamela Mouser, MD, showed that Makenzie could be headed toward type 2 diabetes, and liver enzyme levels indicated fatty liver disease. Both conditions are often caused by being overweight and can have serious consequences. If unchecked, fatty liver disease can eventually lead to cancer or even liver failure.
Physicians say increasing numbers of kids like Makenzie are at risk for these diseases, setting them up for a lifetime of medical and psychological problems. The culprit? Skyrocketing rates of childhood obesity. Over the past two decades, the prevalence of obese children has doubled, and the number of obese adolescents has tripled, according to the American Academy of Pediatrics. American kids are heavier and less active than at any time in human history — nearly one in three are overweight.
The problem is so pervasive that a lot of people no longer seem to know what a normal-weight child should look like, says pediatrician Nalini Gupta, MD, of Group Health Medical Centers Lidgerwood clinic in Spokane. "Children come in and are normal weight, and parents are worried they're too thin."
First Lady Michelle Obama is spearheading the national Let's Move campaign with a goal of reducing childhood obesity within a generation. Let's Move points out that if we don't solve the problem, one-third of all children born in 2000 or later will suffer from diabetes at some point, while many others will face heart disease, high blood pressure, cancer, and asthma because of their weight.
How Did We Get Here, and So Quickly?
Experts give these reasons for skyrocketing obesity:
- Cars and buses now trump the bike ride or brisk walk to and from school.
- Gym class and after-school sports have been cut, and kids aged 8 to 18 spend an average of 7.5 hours a day using entertainment media.
- Only one-third of high school students get the recommended levels of daily physical activity.
- Families eat fewer home-cooked meals, favoring restaurants where they consume higher-calorie meals than they would at home.
- Kids snack more. Thirty years ago, they ate just one snack a day. Today, the trend is toward three snacks, resulting in an additional 200 calories a day.
- Restaurant portion sizes are two to five times bigger than they were in years past.
- Kids are drinking more sugar-sweetened beverages. Between 1989 and 1991, about 6.5 percent of their calories came from sugar-sweetened drinks; today it's 11 percent, according to the Journal of the American Dietetic Association.
It seems like a hard trend to turn around. But things can change, and innovative programs and studies by Group Health physicians and researchers are showing promise.
Programs Focused on Reducing Childhood Obesity
Pediatrician and researcher Paula Lozano, MD, of the Group Health Research Institute (GHRI), is at the forefront of efforts to help families struggling with weight issues. She and Group Health pediatrician Sarah Rudnick, MD, oversaw the Group Health Family Wellness Program, a pilot program funded by GHRI that recently ended. Approximately 50 families participated in the program during its three-year duration.
"The good news is, it's not a mystery how we got this way," says Dr. Lozano, who answers e-mail at her computer standing up to help stay active during the workday. "We just need to eat less and move more. The bad news is it's a very hard thing to do. We're up against a lot of barriers. We all try to be good parents, but in this environment, we need to be super parents."
What that means is that families need to remake their habits. That's what they learned to do in the Family Wellness Program. The program required a parent and overweight child to enroll together. Over a 16- to 20-week period, participants wrote down everything they ate each day, learned about calories and healthy food habits, set goals, embraced exercise like regular walking, and developed ways to cope with problems or setbacks. Children attended one session a week with a parent in the evening, a component that was meant to both motivate participants and hold them accountable, says Dr. Lozano.
"We worked on parents taking charge of setting boundaries at home," adds Dr. Rudnick, whose practice is at Group Health Medical Centers Bellevue clinic. She explains what that means: "If the kids go into the refrigerator, there should be a healthy snack there. And we want families to limit TV time and where televisions are located in the house. We know children will be in trouble if there are TVs in their bedrooms." Several studies have shown that children who have a TV in their bedroom are more likely to be overweight.
Parents were also encouraged to engage in what she calls active activities with their kids, such as going for hikes or for swims. And the whole family was asked to examine ingrained notions of how they eat and drink — such as how frequently they go out to eat, how often they consume fast food, and how much soda they drink. The program demonstrated that adopting guidelines, such as goals for calories and physical activities, helps achieve success. "You need accountability and monitoring, or you're not going to see changes," says Dr. Rudnick.
She acknowledges that it can be very difficult for families to make healthier choices to help kids reach appropriate weights, but the Family Wellness Program demonstrated that it can be done when the whole family participates.
While analysis of the program results is still under way, it's clear that both kids and parents benefited, says Dr. Lozano. Adults lost weight and children reduced their body mass index (BMI) percentage. The latter is a good measure of success for children since they are still growing. They may not lose weight, but if they gain an inch of height, their BMI goes down, she explains. But many children did also lose weight. "We learned what we needed to learn from this pilot. Now we will look for ways to integrate what we learned into our medical practices at Group Health Medical Centers in a sustainable way, so that more of our patients can benefit."
That said, the earlier obesity is addressed, the better. "Age is very important," Dr. Lozano says. "Once kids are 13 or so, they really don't want parents telling them what to eat or how to be active."
A pilot program similar to Family Wellness is under way in the Spokane area, overseen by Dr. Gupta and pediatrician Cicely White, MD. It's called the Countdown to Healthy Living program, and is funded with a grant from the Group Health Foundation. "Both programs are based on the principles of behavioral, family-based interventions to treat childhood obesity, though there are some differences in the program structure and how it's delivered," says Dr. Gupta.
She and her team are still determining what works best, but some factors are emerging. "What has worked in families who have been successful in managing the weight of their children is a strong commitment from the adults towards a healthy lifestyle for the family," says Dr. Gupta. "It's still too early in the timeline of the pilot to comment on the weight loss and maintenance in the enrolled families. However, the families who have attended most of the sessions are the ones who have made the necessary changes to help their children lose weight."
The Best Path Is Prevention
Of course, the best time to tackle the problem is before kids become overweight. "Prevention is far easier than treatment," says Dr. Lozano.
Dr. Gupta says detailed conversations with families can make a difference. "I go over growth charts to see if a child might be overweight," she says. "If so, that's a time to point out that the trend is going up. I ask the parents if they have any concern about it, what their feelings are. There's a good chance they've been wondering about it."
Most families are open to the conversation. "I show on growth charts that this is what I predict Joey or Jennifer will weigh at age 14 or 15, but if you make small steps, we can prevent this from happening."
Dr. Gupta schedules an appointment to discuss changes the parents can make for their child's health, and the health complications and self-esteem issues that being overweight can cause.
She also discusses life factors such as working hours and child care to help them uncover and overcome what might be contributing to their child's weight issue. "I try to motivate them to come up with their own solutions," she says. "I tell them what has worked with other families, and also emphasize that the whole family has to change. That hits home with a lot of families."
The Road to Success
For Tanya Wanchena and her family, support from the Family Wellness Program helped them make needed changes. It also helped that the whole family — including stepfather Mel Longley, father Tim, and normal-weight siblings Ryon and Haleigh — were also supportive.
When Tanya and Makenzie enrolled in the program, Makenzie weighed 195 pounds, much more than she should have. "It was scary," Wanchena says of Makenzie's test results in the fall of 2010. "We didn't know exactly what we needed to do. We had a sense we needed to change, but we weren't quite sure how to do that." The family learned that there is no treatment for fatty liver disease, but that it can often be turned around by weight loss.
They went through the program twice, and have changed the way they eat. No more refined carbohydrates, foods with high fructose corn syrup, and cured and fatty meats. "We have tons of veggies," says Wanchena. "We now have whole grain bread, whereas before we were a white bread family. Cookies, chips, we don't have any of that anymore." They seldom eat out now, and a typical dinner is baked chicken, vegetables like broccoli and asparagus, and strawberries for dessert.
They've also integrated exercise into their lives. "Makenzie did really, really well. She began exercising more; we started going on evening walks, a 3-1/2 mile walk up and down hills. I also joined an exercise 'boot camp' and Makenzie started coming with me over the summer, six days a week."
Makenzie says, "I worked hard making changes, eating better foods and exercising every day. At first it was hard, but I just stayed positive. I didn't want to let myself down." She made friends who were also in the program and says the program leaders made it fun. And perhaps most importantly, she adds this lesson learned: "Losing weight will help you live a healthier life."
Mother and daughter have both benefited from the program. Wanchena, who has always struggled with her weight, dropped 75 pounds, and Makenzie lost 45 pounds. Best of all, Makenzie's recent lab tests have all been very good. Her liver function has returned to normal, and her risk for diabetes is now greatly reduced.
While not every family who has a child with a weight problem will participate in something like the Family Wellness or Countdown to Healthy Living programs, the message is clear. Making changes as a family is what will really make a difference.