THE OVERVIEW: OBESITY EPIDEMIC DEFIES EASY ANSWERS

Here’s a solid article from ANNA SCHUMANN at CMN.com.

As a 193-pound seventh grader in the 1970s, Keith Tobias Scruggs was picked on a lot in school.

“It’s a depressing part of life,” he said. “Heavy kids are teased by their friends and family. What people say hurts, and it can hurt for a long time.”

Scruggs turned his life around as a teenager and in college. He was a collegiate national power lifting champion and held the national dead lift record for more than five years. He became a certified personal trainer and managed his university’s recreation and fitness facility. Despite holding undergraduate and graduate degrees in engineering as well as a master’s degree in business, Scruggs left the engineering field in 2000 to focus on personal fitness. He now owns a gym and is working on a doctoral degree in health and wellness psychology.

Nothing will ever make him forget what it was like to be obese as a child. And due to his experiences, self-esteem is the second-biggest issue Scruggs’ Houston-based non-profit, the B.O.N.A. Foundation, focuses on. The first is morbidity.

“For me, it was a personal and psychological issue,” he said. “Today, it’s a life issue. For some of these kids, it’s a life or death issue.”

Childhood obesity is becoming a life or death issue for more people every day. The Centers for Disease Control and Prevention estimates that childhood obesity rates in America have nearly tripled since 1980.

“There are more and more kids having adult problems, like hypertension and diabetes,” Scruggs said. “Well, they used to be called adult problems. ‘Adult onset diabetes’ isn’t always adult-onset now.”

The Root of The Problem

It was the 1980s when several factors combined to create a perfect storm for the rise in obesity, said Dan Kirschenbaum, author of several books on the psychological treatment of childhood and adolescent obesity, including the first book geared toward psychologists treating obesity in 1987. Kirschenbaum is also president of Wellspring, the leading provider of youth obesity treatment camps in the country, and is director of the Center for Behavioral Medicine and Sport Psychology and professor of psychiatry and behavioral sciences at Northwestern University Medical School.

From the early 1960s to the early 1980s, the percentage of American children who were overweight or obese was roughly 10%, he said. In the 1980s, that percentage started doubling, and he estimates that the number of overweight and obese children is now closer to 38% of the entire adolescent population.

Beginning in the 1980s, culture, especially as it related to general fitness, changed rapidly, he said. Electronics such as video game consoles were becoming common; portion sizes at fast food chains and restaurants increased; the cost of food remained relatively cheap compared to other goods; advertising practices for such foods changed; and the use of high-fructose corn syrup, a 1970’s invention, became more prevalent. All of those factors combined with the change in family structure—more children had two working parents than previous generations, and more parents were becoming increasingly afraid of letting their children play outside—led to the childhood obesity boom. The people who came out of that era with weight problems, he said, have a biological predisposition to being obese.

Being overweight has consequences far beyond physical appearance, including heart disease, stroke, liver and gall bladder disease, sleep apnea, osteoarthritis, and gynecological problems. CDC research has shown that children who are obese are more likely to become obese adults, unless they are treated early on.

Socioeconomic Disparity

There is also a link between socioeconomic status and childhood obesity. One in three low-income children is overweight or obese before their fifth birthday. According to the CDC, it is because low-income families generally have less access to healthy food choices and opportunities for physical activity. Many low-income communities lack sidewalks, green space, parks, and recreation centers.

In Scruggs’ organization, volunteers conduct after-school programs in Houston’s most at-risk schools.

”We work with troubled kids and overweight kids to give them something to do after school,” he said. “We find a lot of the time, they’re the same kids.”

For three hours after school, volunteers play with the students and also spend time tutoring them. The B.O.N.A. Foundation also works with parents as much as possible to teach them about healthier food options or, at the very least, portion control.

”The fact is, it does cost more to eat healthier,” he said. “It’s really hard for struggling parents to understand why they should cook chicken breasts and vegetables for their family when it is much cheaper and easier for them to get fast food. What we try to show them is, even when finances don’t allow for healthier food choices, they can control how much of it they eat and feed their children.”

The Psychiatric Approach

Kirschenbaum gives parents information about a four-stage, seven-step treatment program for overweight children. Not every child will need all seven steps in the treatment, but all treatment steps make one key assumption: a child’s obesity is a family issue.

The seven-step approach begins with medical management: asking medical personnel for guidance on where a patient should be, and managing any consequences they may already be facing due to weight. Next, patients should receive information on diet and exercise. Third, parents may need to make environmental changes such as buying bicycles as a primary means of transportation, eliminating all high-fat foods from a home, putting exercise equipment in front of televisions, or removing televisions and computers from bedrooms. Support groups are encouraged as a way to help children and families stay focused. The fifth step begins cognitive behavior therapy through clinic or short-term immersion. If short-term, then long-term immersion therapy programs don’t work, the last of his steps is bariatric surgery, which he recommends for patients who saw little success after at least six months of trying other methods. It is key that post-surgery, a multi-disciplinary approach is taken to treat the psychological aspects of the patient’s problem as well.

Obesity Politics, Policy, and Increased National Awareness

National attention was heightened to the childhood obesity epidemic in 2009 when Barack Obama was sworn in as president and First Lady Michelle Obama created the Let’s Move initiative. The Let’s Move initiative is designed to take a comprehensive look at childhood obesity and solving the problem through several means, including parent education, healthier food choices in schools, the creation of community gardens, and increased activity levels.

According to its site, Let’s Move seeks to involve parents, elected officials from all levels of government, schools, health care professionals, faith-based and community-based organizations, and the private sector. Athletes and celebrities have been quick to jump on board. The question it poses, aside from how effective it can be at its core, is whether or not it will lead to policy changes, said Christina Greer, assistant professor of political science at Fordham University. Greer’s research focuses include American politics, black/ethnic politics, urban politics, quantitative methods, and public opinion.

The premise seems noncontroversial—the public wants to help kids, the public wants a healthier general culture, and research has shown what taxpayers spend on the care and treatment of weight-related issues in health care facilities.

”But,” Greer said, “it’s never as simple as sick kids.”

”If Obama is reelected, we could start to see a policy shift,” she said. “The potential is infinite, but many will wonder, ‘Will my kid have to take gym?’ ‘What will happen to school nutrition?’ That has already been the rhetoric surrounding his presidency, so the administration will have to watch that. But (Michelle Obama) could pressure her husband to do something and could get more involved with the education and agriculture meetings.”

Not only would the implications of such involvement be huge—when Hillary Clinton was First Lady, she was often accused of overstepping her bounds for involvement in healthcare policy—but the actual policy changes would be drastic, she explained. Creating community gardens and decentralizing agriculture would mess with subsidies that have been in place for years. It would toy with the income of farmers and grocers, and the role of lobbyists in agricultural industries. That’s not to say policy couldn’t change, however.

”Things may change in the system, there are just a lot more players than anyone wants to admit,” Greer said. “It’s more than just Michelle Obama, overweight kids, athletes, and celebrity chefs.”

The Bottom Line

What it ultimately comes down to, Kirschenbaum said, is that parents and kids can make choices that will impact their weight and health. They can make diet substitutions—even simple ones such as low-fat potato chips for regular potato chips—and see a difference. They can buy pedometers for their family and set step goals for each member. They can help them make good decisions now so that when they grow up, they will continue to make good health choices.

”Parents are willing to spend all kinds of money and time to make their kids better soccer players when they know they’re not going to become professional athletes,” he said. “Why not spend the same money on their health, and make a difference in these kids’ lives?”

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