Adolescent Medicine 
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by Ellen Lane for Daily Press Nicknames,
teasing and jokes — overweight children get more than their share of all
three. But kids who carry around extra pounds also are setting themselves up for
more serious problems down the road. Overweight children are at risk for joint problems, diabetes and depression with
onset during adolescence and high blood pressure, heart disease with onset
in early adulthood, says Dr.
Gilberto Velez-Domenech, chief of adolescent medicine at the Children’s
Hospital at Westchester Medical Center There are about twice as many overweight children
in the United States as there were 30 years ago. Roughly 25 percent of all children
and adolescents are considered overweight, and just one percent has a specific medical condition
that triggers weight gain. “It’s really disturbing, because we know
exactly what these kids can run into," Dr. Velez-Domenech says. So what’s to blame? There are two main culprits:
Not enough exercise and too many high-calorie foods. Instead of playing outside,
many children are spending hours a day glued to TVs, playing video games and
surfing the Internet. They’re also munching on fast food, chips and
other fatty snacks. With more two-career families, parents often don’t have
time to watch what their children are nibbling on, or to cook healthy meals every
day, Dr. Velez-Domenech says. It can be hard to tell if a child is too heavy
because a child's body is always changing. Children often gain weight just before the growth spurt and they also
put on more fat as they enter puberty. Most doctors rely on an
index called the body mass index. The BMI is a calculated number — weight in
kilograms divided by height in meters squared. Doctors compare that with results
from children of the same sex and age. Generally, a child with a BMI in the 95th
percentile or higher — meaning the child’s index is higher than 95 percent
of other children — is considered overweight. Doctors differ in how they define morbid obesity,
or a weight high enough to put a child at greater risk for serious health
problems. Generally, that’s when a child is 100 pounds or more above ideal
body weight. Parents shouldn’t panic if their child looks a
little chubby. But rolls of fat and lots of extra padding on the abdomen, thighs
and cheeks — common areas where fat deposits — often mean trouble. A weight
gain that’s much faster than a height gain also isn’t normal. “A lot of it is just plain common sense,” Dr.
Velez-Domenech says. “If you’re suddenly buying bigger and bigger clothes
and it’s not because of the growth spurt, there probably is something wrong.” Medical Center doctors who treat overweight
children check for metabolic problems and endocrine disorders
that can trigger weight gain. In girls, doctors also have to rule out
abnormalities of the reproductive system, particularly if
menstrual irregularities are present. Helping children lose weight can be tricky because
cutting calories too drastically can interfere with normal muscle and bone
growth. Children also end up hungry, miserable and more likely to quit trying to
lose weight. And an outright ban on sweets like chocolate can make the child
crave them even more. In younger children, the strategy is to hold weight
steady so they will thin out as they grow taller. In teen-agers who have reached
puberty and have already gone through a growth spurt, Dr. Velez-Domenech
typically starts by cutting their calorie intake by about 50 percent. With all ages, doctors emphasize fitness and health
instead of weight. That emphasis helps children keep a positive attitude and can
prevent eating disorders from striking down the road. “You don’t want them to get hung up on the
numbers,” Dr. Velez-Domenech says. “Kids are constantly bombarded with the
message that fat is bad. If they hear the same message from a doctor who is
pushing for quick results, they can get carried away. You don’t want to get it
in their heads that something is wrong with them or that it is their
fault.” Exercise is key. Children can start by walking 30
minutes a day, at a brisk pace, and build from there, Dr. Velez-Domenech says.
Parents can set a good example by staying active themselves. It's
also never too early for children to learn good eating habits. Even very young
children shouldn’t be forced to eat if they aren’t hungry — meaning plates
don’t always have to be clean, as long as the child is eating nutritious
foods. By the time a child is 2 years old, extra fat
shouldn’t be shrugged off as normal baby fat. Young children who are
overweight are more at risk for staying that way.
“If the whole family is involved in staying fit
and healthy, the child is much more likely to be successful,” Dr. Velez-Domenech
says. “It should be a whole lifestyle approach.” |
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