Cleaveland: Obese kids face added health risks

Life expectancy will fall and health care costs will soar unless we address a worsening epidemic of childhood obesity.

From 2003 to 2007, the percentage of overweight children ages 10 to 17 increased from 30.6 percent to 31.6 percent. Within this group, the percentage of children who fit the definition of obese rose from 14.8 percent to 16.4 percent.

Childhood obesity foreshadows obesity in adult life with its associated risks of diabetes, elevated blood fats, heart and vascular disease, and sleep disorders. Obesity could become the new tobacco in terms of its impact on the nation's health.

Five states -- Tennessee, Arkansas, Mississippi, Georgia, and Kentucky -- have significantly higher rates of childhood obesity than other states. In Tennessee 20.6 percent of 10- to 17-year-olds are obese: 9.8 percent of Hispanic children, 19.2 percent of white children, and 28.6 percent of black children.

Nationwide, children on public health insurance programs are much more likely to be overweight or obese than children who are privately insured (43.2 percent vs. 27.3 percent). Rates are higher in neighborhoods that lack access to parks and recreational facilities and in neighborhoods deemed unsafe and unsupportive.

Recent studies show that prevention of obesity must begin during pregnancy and infancy. If a mother smokes or gains excessive weight during her pregnancy, her child has a significantly higher likelihood of obesity. If she nurses her infant for only a short interval, he will have a higher risk of obesity. Brain and glandular regulators of appetite and weight are established before a child has a chance to learn and to make healthful dietary choices.

Schools must play an active role in combating obesity. Lunch programs can make a difference if fruits, vegetables and whole grains replace foods with high sugar and fat content. Soft-drink and candy machines have no place in schools.

British chef Jamie Oliver has led a crusade for healthful menus in American schools. His weekly show on ABC highlights the barriers to dietary reform: bureaucratic inertia, higher costs for garden produce, and food preferences that children bring from their homes.

When school budgets tighten, physical education programs are often among the first programs to be cut. Guidelines formulated by the U.S. Department of Health and Human Services advise an hour of moderate to vigorous exercise daily for school children. Two-thirds of children do not meet this standard. We have a choice: pay for proper food and exercise programs for students now or pay much more for their declining health as adults.

The most controversial solution proposed for addressing childhood obesity is a tax on sugary drinks. T.R. Frieden and colleagues discuss the effects of a one cent per ounce tax on sugar-containing soft drinks in the February issue of Health Affairs.

They estimate this would raise the cost of each beverage by approximately 10 percent and would reduce annual per capita consumption by eight thousand calories, preventing a yearly weight increase of more than two pounds per person.

Fast-food restaurants could play a defining role in preventing childhood obesity through their advertising and their menu selections. By posting nutritional information prominently, customers would know fat and calorie content of choices before ordering.

Children's menus would feature baked instead of fried potatoes, juices and milk instead of shakes and sodas, and vegetables and fruits as side orders.

Profit could be realized through an emphasis upon healthier food. With their expertise in marketing, McDonalds and Burger Kings could reshape the mealtime expectations of young customers.

Finding solutions to childhood obesity will not be easy. Coordinated efforts of government, businesses, schools, and families are urgently needed to safeguard the health of youngsters.

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