Transcription:
The Childhood Obesity Epidemic

Melanie Cole (Host):  Childhood obesity has more than doubled in children and quadrupled in adolescents in the past thirty years, reaching what experts are now calling epidemic proportions. My guest today is Dr Mihir Tolat. He's a pediatrician with Florida hospital. Welcome to the show, Dr Tolat. Tell us what's going on with children today and the obesity epidemic that you are seeing as a paediatrician and what are your theories on some of the causes?

Dr Mihir Tolat (Guest):  Melanie, childhood obesity has become not only a national but a global health epidemic. In the US, nearly one third of the children that are aged two years to nineteen years are overweight or obese according to the 2014 statistics by CDC, and worldwide nearly 41 million children under the age of five are either obese or overweight. It is very concerning to me as a pediatrician and to parents because these children who are obese tend to become obese and overweight as adults, putting them at higher risk for heart disease, for Type II diabetes, for dyslipidemia and also for social and emotional difficulties such as stigmatization and low self-esteem. So, it's really important, as a pediatrician and as a parent, that we deal with this epidemic as early as we can and as young as they are, before it get to manifest it’s ugly head as an adult.

Melanie:  So, Dr. Tolat, as far as health effects of childhood obesity, you are seeing even things that used to be just adult diseases, like diabetes Type III, which used to be called “adult onset”--it's not anymore. High blood pressure--you're seeing these things in children now, yes?

Dr Tolat:  Yes, it's becoming more prevalent especially with poor dieting and lack of exercise that's been going on in society today. Now these diseases that we saw only in adults are also happening in adolescents.

Melanie:  So, what are you as pediatricians doing if a parent comes into your office, are we taking BMIs of children now? Is this a standard thing to do? And then, how do you talk to parents about what the results of a BMI are?

Dr Tolat:  By definition, the BMI are calculated in children that are two years and older. Under the age of two, like from babies until about twenty three months, we take what we call weight for height values, and above 95 percentile, even in this age group, is somewhat concerning. So, if they are at that level, we try to follow them more closely than we would otherwise. We take BMI every health care visit for ages two years and beyond and any BMI that's between 85th percentile to 94th percentile is considered overweight, and above 95th percentile or a BMI of 30 is considered obese. Once we have these values, we take further actions into finding out what are reasons of their BMI’s are so high and what we can do as pediatricians, as parents, as society to help them lose weight and overcome these challenges.

Melanie:  Do you ever run into resistance from parents when you tell them that their child has a weight issue, and sometimes you would see that the parent has a weight issue as well?

Dr Tolat:  To be honest with you, a lot of times, most of the obese that we do see have parents that are also obese. And, there are a lot of racial and ethnic disparities in groups on what healthy is by definition. A lot of Hispanic communities feel that having rolled on babies or chubby cheeks on a child is what is claimed as healthiness as opposed to other ethnicities which view them as “my kid is overweight” or “my kid is obese”. And, I've also seen that a lot of times it's a family oriented approach. So, many times the practice of the parents in terms of their diet and exercise, the kids also have a similar kind of lifestyle because they look up to the parent as a role model for what is ideal and what is appropriate in terms of diet and exercise and they kind of follow the same trend, making them also obese, like the parents.

Melanie:  What do you tell parents who say to you, "But, my kid is a picky eater. He won't eat vegetables and he doesn't really like to eat healthy food, he just likes his junk food"?

Dr Tolat:  We counsel parents on the harmful effects of unhealthy foods and what it can lead to later in life but, to be honest, education and counselling can only go so far. There has to be some structured behavioural modification that has to take place if we are to see any changes. Like, we have to make sure we tell parents that there are several culprits of obesity that have been identified, such as intake of sugars in beverages, like soda, ice tea, sweet tea, sports drinks, energy drinks, and juices that are advertised as juices but they only contain 10% juice. We really tell parents that we want to minimize that because that's a lot of excess calories which are of no use. So, AAP actually recommend that juice only given in amounts of four to six ounces in children that are one to six years, and no more than twelve ounces for those above the age of six years. So, no more than that. Not only do these foods and  beverages lead to excessive weight gain but also can lead to tooth decay. The other thing we also recommend for parents is to minimize the foods that are increased energy dense, such as fattened rich meat, fried foods, fast foods, sweets, cheeses. On contrary, we tell them to go for healthier options. So, it's always important because kids want options. It's not like you can be an authoritative parent and say, "You must eat this, this, and this." You want to give kids options but you want to make them choose from the healthier options. You have the veggie sticks, you have the fruits, and you have the greens. Try to help them choose from a healthier version of a plate as opposed to unhealthy foods. The other culprit that has been big in obesity is television viewing The American Academy of Pediatrics recommends that children under the age of two years should not be watching TV and the ones that are above two years limited to no more than two hours a day. TV viewing, or any kind of games, computers or laptops, are all sedentary forms of activities which takes away from the time that they can actually utilize to do physical activity and, also, a lot of the commercials on TVs promote unhealthy things. There are a lot of commercial about fast food restaurants and unhealthy juices and foods. So, it promotes those as opposed to promoting healthy food. We also recommend that they eat age appropriate content, like each age has certain amount of calories that they need to grow. There's no need for access calories beyond that because obesity is basically an equation of how much energy you take in and how much you put out. It's believed that it's easy to control what we can put in and the amount we take in, as opposed to burning it off  That is a much more rigorous process to actually burn and do physical activity to burn all the excess calories we put in. So, it’s really important that the foods we eat are low in calories and are low in energy. They're healthy and we have portion control in terms of how much we eat. Besides the nutrition aspect of it, the other aspect that we push on is physical activity. The American Academy of Pediatrics recommends that kids at least need to do sixty minutes of moderate to vigorous activity per day. Hopefully, some of that could be done in school with gym or other activities but a lot of the stuff could be done as the family. You don't have to be enrolled in the gym. You can go for hikes and go for a walks. You can walk the dog and roller skating. You can use stairs as opposed to using the elevators. You can walk to school, if it's feasible. We try to promote all these things to help work on this whole obesity epidemic.

Melanie:  That's great advice, Dr. Tolat. Limiting screen time as the AAP recommends and offering that healthy choices as opposed to a choice between a banana and maybe something that's very unhealthy like a piece of candy. Those are all great advice. Now what about the schools because this is a bigger problem than we even realize. The schools are cutting gym and recess in favor of academics but kids need to run around, get their beans out. What do you tell parents about community involvement and getting their children more active to prevent childhood obesity when the schools sometimes have to cut some of that activity time?

Dr Tolat:  Yes, I understand the academic portion of schools but, as a community, we need to work with the schools to promote these kinds of activities. Like I said, it's not only about running around. A lot of the stuff that can also be done without an official recess or gym class, or something, but we should promote a gym class, that helps build self-esteem and it helps promote healthy habits. The other thing with school that is important is that a child spends a lot of their hours of the day in school. It's important to know what they're feeding in school. So, parents should inquire about the menu at school, at lunch cafeteria, that they're offering healthy options because you don't want at home to promote healthy eating while at school they're getting pizza and other kind of unhealthy foods.

Melanie:  That's great advice for parents to really make sure they inquire at their schools about the menu that the kids are getting. So, wrap it up for us, Dr. Tolat, with your very best advice for parents in this epidemic of childhood obesity and the dangers of children's health and what you want them to know about prevention or working with obese children?

Dr Tolat:  Alright. So, basically, I would encourage parents to buy fewer food associated with obesity and, if they buy these foods—like, if it's a birthday or something like that--it should be bought right before that event happens and it should be disposed right after the event is over. If you were to store that in the fridge, it should not be very visible on the front. It should be maybe in the back of the fridge where it's not visible, and it should be preferably covered in aluminium foil or something that's not a see through thing because lot of the times when some stuff is closer to us we are more prone to utilize those foods as opposed to ones that are further from our reach or further from our sight. I also recommend limiting the serving size of meals, use smaller size plates, bowl, spoons for foods that are higher in calories versus bigger sizes for these items, if the food that we're giving are lower in calories and healthier food. Decrease that sedentary lifestyle options by removing televisions from the bedroom and areas where food consumption is done. I would limit the use of video games and computers for sleep time and physical activity. This whole thing basically, I'll be honest with you, is a family based interventions. So, they're more effective than if we just spoke with a child, the family has to work together like I said, because children look up to parents as role models, so what the parents do, the children generally tend to model. If the parents themselves want their children to become healthy adult, the parents have to take that initiative now themselves to also start living a healthier lifestyle.

Melanie:  Thank you so much for being with us Dr Tolat, it's really important information. You're listening to Health Chat by Florida Hospital, and for more information you can go to fhpediatricians.com. That's fhpediatricians.com. This is Melanie Cole, thanks so much for listening.