Transcription:
The Childhood Obesity Epidemic

Melanie Cole (Host): Childhood obesity has increased from a relatively uncommon problem to one of the most important public health problems facing children today. Here to tell us about that is Dr. H. Matias Jasin. He’s a pediatrician with BayCare Health System. Dr. Jasin, tell us about the current state of the childhood obesity epidemic that we are seeing today, because now it is being called an epidemic.

H. Matias Jasin, MD (Guest): Yes, it is, and this is not something new from the pediatricians’ perspective. We have been seeing a progression of this over almost three decades. The latest studies are showing that depending on exactly what part of the country you look at, but overall, almost 20% of children under the age of 18, are obese. That comes along with all the health consequences that come with carrying all that extra weight.

Host: What’s the definition of childhood obesity and obesity in children in general? What’s the difference between being overweight and being obese?

Dr. Jasin: Right. So, that’s a really good question. There’s a lot of confusion surrounding it. So, the means that we use to sort of decide or to screen for obesity is something called a body mass index. So, most people have heard of BMI and it takes weight and height into account and puts it through a pretty simple little math formula and allows us to sort of plot your specific – a specific child’s weight and height and put it onto a graph. What we do is, we compare each specific child to data that we have that was gathered before the obesity epidemic began and compare your child at his or her age to 100 other children, per se and that gives us a percentile. So, it tells us where your child sits compared to 100 other children their age.

Being overweight is defined as being at the 85^th percentile or higher and being obese is considered to be at the 95^th or above percentile. So, for example, if a doctor is trying to tell you that your child is overweight, that means if you take 100 children exactly your child’s age, then at least 85 will have a BMI less than your child. So, your child falls in that top 15%. If you are obese, your child will fall in the top 5% of children of similar age.

Host: This is a big question Dr. Jasin, but why is obesity a growing problem and I look to things like school, gym, and recess and the built environment? It is so complicated, but in your opinion, why do you think this is becoming such an issue.

Dr. Jasin: Well, I agree with you completely it’s definitely a multifactorial issue. I think the things that we can point at over the last couple of decades anyway, that are growing in their importance are the availability of processed foods that taste good to kids but may not be the best things for them and certainly, depending on the school district that your child is in school in, you may see a lot of those or in some more progressive school districts, you may see lots of better foods with fewer processed foods.

The second issue that has been arising over the past ten to fifteen years, has been the amount of screen time that kids are getting, the amount of time that they spend on their phones or on their tablets and that is time that they are not moving through their environment and being physically active.

Host: Are there certain risk factors and a genetic component? Dr. Jasin, do you happen to notice that when you see an obese child, the family itself tends to be overweight and how as a pediatrician do you approach a family in that situation?

Dr. Jasin: So, the answer to that is yes and no. There certainly are cases where there is no history in the family of people being overweight and then you have a child that’s overweight. But we do tend to see that there is a familial connection. There is evidence that some forms of obesity are genetically related. It’s debatable what percentages of kids and adults that are obese have mainly a genetic component. Most studies that I am aware of have sort of come down both sides. So, there’s environmental components as well as genetic and it’s impossible really from a pediatrician’s perspective to determine that, but if the parents are also overweight, whether it’s genetic or lifestyle; we do tend to see kids that have a higher propensity for obesity.

Host: One of the saddest things about this epidemic in my opinion Dr. Jasin, are the health risks and the comorbid conditions. We never saw diabetes type 2 which used to be called adult onset, now you could see it in a nine-year-old or high blood pressure, heart disease. Tell us about some of these health risks and what you’re seeing as a pediatrician.

Dr. Jasin: Absolutely. So, the prevalence of type 2 diabetes in adolescents and even preadolescents is something that 30 years ago, was extremely rare and usually happening only in kids that had some strong genetic reason for either overeating or they don’t metabolize like normal children and that represents now a very small portion of kids that are obese and overweight. So, we are seeing an increase in whether it’s full blown type 2 diabetes or just the beginning stages of diabetes. We are definitely seeing increases in hypertension and also maybe not what most people think is a direct health consequence, but we also see increases in depression, anxiety and the effects of bullying on kids that are overweight. All of those have been on the increase certainly during the last decade.

Host: That’s an excellent point Dr. Jasin. If a parent thinks their child is obese, what can they do? Are pediatricians using a screening tool aside from BMI? Is there a history taken and how is that all worked with the family? What can a parent do?

Dr. Jasin: Well, that’s a two-pronged question because there’s a lot of evidence out there that parents tend to underestimate their children’s BMI, or I should say they underestimate whether the child is at a healthy weight or not at a healthy weight. And this has changed over time. So, it seems that the American public is getting used to looking at heavier children and so, they adjust what they think is normal according to what they are seeing around them.

So, we don’t get many parents that bring their children in worried about their child’s obesity. It’s usually something that comes from us because they see their child as not being overweight. So, the tools that we use basically are I mean, BMI. That really is the definition of it. But as we see weights or eating habits or lack of exercise as becoming a significant problem, we certainly warn parents about the possibilities of what may come as far as weight and health go.

Host: So, then let’s talk about some things that parents, the communities, the school, pediatricians just, it takes a village, and this is an epidemic. Where do you think diet and nutrition play a role? What can we do to change it? You mentioned processed foods. Do you think the diet industry is contributing to some of this or even urban deserts. There are a lot of reasons kids can’t get these healthy foods.

Dr. Jasin: Exactly. So, we do see trends within socioeconomically less successful areas where access to fresh healthy foods is decreased and we do see increases in general BMIs as well as true obesity and things like that. So, very complicated problem. But one of the sort of national issues that we have to deal with is that it is very cheap in this country to produce high fructose corn syrup because of government programs that keep farmers in business doing – growing lots of corn. But there are no subsidies for growing broccoli or green beans or fresh tomatoes and so, consequently, those fresh vegetables are much more expensive than they could be or at least more expensive than some of the products that come from corn that turn into the processed foods that are very high density of poor calories.

The other issues that we run into as well, are we touched on before, as far as school systems looking for cheap ways to provide foods that they know kids will eat and that isn’t always necessarily the best choice. I think probably the place to intervene on this issue is early in childhood when kids are toddlers and that’s where the beginning and most of that happens in the household and dealing with things when kids are already in their early teens or adolescence and overweight; is much more difficult.

Host: We’re obviously not going to be able to solve this huge problem in this segment today. But if you could give the best advice what you would tell parents about exercise, screen time, healthy foods, all of these things and I’m sure parents ask you if there’s a treatment. So, while you are giving your best advice, just speak a little bit about treatments you might try and if a child is ever even considered for things like bariatric surgery.

Dr. Jasin: Okay. Well, I think again, I want to reiterate the best and most important time to try and avoid the consequences of obesity is in toddlerhood. I call it, at least with my patients, we talk about it as mealtime hygiene. And that’s the way I sort of try and explain it to parents. The basics are pretty simple. There are set times for eating and no eating will occur at any other time. The amount of choice that the child has and what he or she eats should be very limited until children are much older. And when I mean older, I mean 14, 15, 16 years old. Because kids younger than that tend to make poor eating choices even if they are aware of health benefits of foods. They will make choices that aren’t consistently good.

Now that’s not the case for every child. But certainly, if you take the general population overall, lots of kids and if you think about a toddler given a choice between having a bowl of ice cream or eating a bowl of broccoli, I mean clearly, they will choose the ice cream most of the time. So, as far as mealtime hygiene, there are set times for eating and if the child is bored or is feeling a little bit hungry before those times; that is not the time to allow them to eat. We learn to deal with our, whether it’s boredom or hunger in between meals by experiencing that and showing the child that they will get through it. And you certainly can offer a noncaloric drink like water to satisfy their little tummies until it’s time to sit down for snack time or sit down for mealtime.

As far as exercise goes, there certainly are lots of places in a child’s life where we are opting to allow them to sit with iPad or sit in front of a movie when we could be pushing them outside and asking them to create something interesting for themselves. It does not have to be a structured activity. It is not – it is okay to ask your child to occupy themselves in the outdoors whether it’s on their bike or just playing in the backyard or in any outdoor facility to just get their bodies moving and if left to their own devices; generally, most kids will find something interesting to do. But it requires having to put up with a child that may at first, protest and that sometimes becomes frustrating for parents. But the fact is, that kids will find things to do if left to their own devices, in a supervised manner obviously. So, getting the kids outside more during toddlerhood and preschool years and things like that would be a great thing.

As far as screen time specifically, the American Academy of Pediatrics has recently updated guidelines on screen time and the general suggestions are accept for screen time where you’re doing things like Facetime where you are actually communicating with a grandparent or something like that; we are really recommending that kids under two not spend a lot of time in front of screens. I believe they have added after 18 months there can be some supervised educational activity where you are actually with the child, with the screen and supervising them only for educational activity. But prior to two years old, kids should not be left to their own devices with a screen.

And I usually for older kids that are already in school, my recommendations have been that strict limits during the school week as far as gaming and as well as just social media and things like that and that can be you know depending on each kid, you might be able to give more or less time but allowing a kid no more than one hour of free play on a screen device during the school week, I think is completely reasonable. And then, depending on the situation for the weekends, you can have some flexibility as far as how much time is spent.

I think finally you asked about treatments. Truly, bariatric surgery for children does happen. It is indicated, but it is usually indicated for really the top percentiles of BMI, I mean kids that are morbidly obese, are clearly suffering the health effects already and the results are usually good. It’s just not always a long-lasting solution. So, there are people that five to ten years after surgery start gaining weight again. So, it may not be without behavioral changes as well, it may not be a panacea of here’s the solution for all obesity. Certainly, there are risks involved with any surgery so it’s something you don’t take on lightly.

For most kids however, unless they are already showing the signs of prediabetes or diabetes; there is no medical treatment that we commonly use. It’s usually behavioral changes. It’s about making small incremental changes to the way that the children and hopefully the family as a whole, is living their life so that things can move forward slowly. The beauty of children when it comes to this issue is that they grow and so the goal isn’t always to lose 30 pounds. Often, if we can just slow down the amount of weight that’s being gained, the natural growth of the child will correct the problem.

That’s sort of just a brief sort of outline of kind of some of the basics of what we would be doing.

Host: It’s so important, the information you’ve given today Dr. Jasin could help so many families and really, it’s a great educational lesson for us all on this epidemic of childhood obesity and thank you so much for joining us. You’re listening to BayCare HealthChat. For more information, please visit www.baycare.org, that’s www.baycare.org. This is Melanie Cole. Thanks so much for tuning in.