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Foiling fat in tots and teens

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Sep 27, 2004 (United Press International via COMTEX) -- UPI surveyed 84 specialists for a 15-part series weighing in on the causes, consequences and costs of a global gain in girth and measures to curtail the corpulence. Part 15 dishes out advice on weight control in the young.


SAN FRANCISCO -- From parents and policymakers to entrepreneurs and educators, it takes a global network to raise a child fit for life.

The swelling number of youngsters overgrown in girth -- which has topped 177 million globally -- bespeaks the enormity of the task in a society saturated with fat-fueling traps.

In a comprehensive report, presented to the World Health Organization May 13, experts warned of the unprecedented ballooning in childhood obesity -- defined as weight more than 20 percent above the ideal for gender, age and height -- and its life-threatening aftershocks, including a bloated risk for type 2 diabetes, heart disease and other ailments once confined to adulthood.

Blaming newfound availability and affordability of heavily advertised, high-calorie, low-nutrition food and drink, addiction to automobiles, resistance to outdoor recreation and explosion in television channels and other sedentary entertainment, the International Obesity Task Force issued an across-the-board call to action.

"It must be concluded that interventions at the family or school level will need to be matched by changes in the social and cultural context so that the benefits can be sustained and enhanced," the specialists stated. "Such prevention strategies will require a coordinated effort between the medical community, health administrators, teachers, parents, food producers and processors, retailers and caterers, advertisers and the media, recreation and sport planners, urban architects, city planners, politicians and legislators."

Few would deny the struggle to keep poundage down is shaping up as an uphill fight.

"The battle with weight gain is a very, very long battle and takes much time and effort," said researcher Linda Dong of the University of Washington in Seattle.

It begins on the home front, as numerous studies reflecting parents' influence over children's behavior can attest.

Even infants can tune into mom and dad's dining habits, scientists from the University of Michigan Medical School in Ann Arbor reported May 1 at the annual meeting of the Pediatric Academic Societies in San Francisco.

"We know the way human beings eat is not regulated by whether you're hungry as much as by social cues in the environment: You eat lunch because it's noon or because you want to take a break or your friends are going out," said Dr. Julie Lumeng, clinical instructor of pediatrics. "This study suggests maybe there are some babies who are much more tied in to ... how people around them are eating. With the obesity epidemic, that could be significant as these infants grow up."

In another investigation, Stanford University psychiatrists who followed 216 newborns for five years found the risk for the start of such disorders as inhibited or secretive eating, binging and vomiting rose each year through age 5, swayed by the mother's unhappiness with her body, dieting patterns and symptoms of bulimia, a condition marked by a revolving cycle of gorging and regurgitating.

"Parents' most important contribution is probably setting a good example," said Ruth Kava, director of nutrition for the American Council on Science and Health in New York City. "Parents either should make themselves knowledgeable about appropriate nutrition for their kids' ages, or get access to people who are."

New federal dietary guidelines, scheduled for release in January as a blueprint for healthy eating, recommend a diet low in fat and cholesterol and rich in omega-3 fatty acids, found in fish, and a lifestyle rife with physical activity at least five days a week.

"I don't think there is a 'one size fits all' ... plan," said Leon Rappoport, emeritus professor of psychology at Kansas Stated University in Manhattan. "(What we eat) should vary depending upon our activity levels, our individual metabolisms and digestive systems."

Few would quibble with choosing broccoli, zucchini and fruit over candy and chips, said Dr. Frederick Samaha, chief of the Cardiovascular Section at the Philadelphia Veterans Affairs Medical Center.

"Fresh fruit is one of the original fast foods," pointed out Dr. Linda Stern, clinical assistant professor of medicine at the University of Pennsylvania in Philadelphia. "Milk is a good beverage choice, and low-sugar, low-fat flavored milks are okay."

She also favors three to four servings of nuts a week and yogurt or yogurt-based, low-sugar beverages at snack time.

Dairy products offer extra benefits as a rich source of calcium, a mineral shown to promote weight loss by triggering fat breakdown.

To nutritionists' dismay, researchers following 106 families with a child ages 3 to 5 at the start of the 12-year survey confirmed adolescent girls in particular have sworn off milk and its derivatives, setting themselves up for disease, including bone-crippling osteoporosis, and increasing their risk of becoming overweight.

Several other studies have noted as milk consumption has plunged over the past 30 years, sugar-coated soda sipping has soared, particularly among the 2-to-18-year-old set.

Dietitian Sylvia Moore offers herself as a nutritionally correct role model.

"I tell people to do as I do," advised Moore, director of the Division of Medical Education and Public Health at the University of Wyoming in Laramie. "Breakfast is very important and can be a good way to begin getting fruit, high fiber whole-grain cereal and/or bread, low-fat milk and a single serving of 100 percent juice -- preferably orange, grapefruit, cranberry or tomato."

She recommends a morning snack for young children, who can gobble up six small meals a day.

Lunch serves as an opportunity to load up on vegetables, fruit and more dairy in the form of yogurt or non-fat milk. Properly crowned salads make a healthy choice. Salmon or tuna straddling a bed of greens accented with tomatoes and peppers can hit the spot. As can a sandwich on whole grain or rye or vegetable soup garnished with fiber-rich legumes.

An afternoon snack of fruit, dairy or nuts can keep child and teen tummies satisfied until the evening meal of protein, from lean meat, fish or vegetarian entree, veggies and a fruitful dessert.

"Only the very active, the young or diabetics spreading out carbohydrates will need an evening snack," Moore instructs.

Parents should offer youngsters a wide variety of tasteful, healthy, attractive edibles. Marjorie Fitch-Hilgenberg of the University of Arkansas likes to suggest children view their plate as a rainbow to be filled with fruits and vegetables in an array of colors.

"Children should not be hungry, so do not restrict their calories, just the kind of food you give them," recommended Gail Woodward-Lopez, associate director of the Center for Weight and Health at the University of California, Berkeley.

Chronically malnourished children score lower on standardized achievement tests, said Dr. Carden Johnston, president of the American Academy of Pediatrics.

"When children are hungry or malnourished, they have difficulty resisting infection and therefore are more likely than other children to become sick, miss school and fall behind in class," he noted.

Studies have linked cutting calories by the young to disrupted metabolism and development, disordered eating, low self-esteem, depression, thoughts of suicide, stress, alcohol, drug and tobacco use and, in an ironic twist, weight gain.

Recent research, reported in Pediatrics, indicates children of mothers who control their every bite face a higher risk of obesity than those left to their own regulatory devices.

"Therapists working with children whose food intake is being restricted often find that these children are begging, scavenging and even stealing food because of their fear of hunger," said UC Berkeley nutritionist Joanne Ikeda. "Assuring parents that infants are born with the ability to self-regulate energy intake and that this ability needs to be fostered, rather than interfered with, is a key message health professionals must communicate."

As a rule of thumb, the U.S. Department of Agriculture suggests "low-active" children ages 4 to 8 swallow 1,500 calories a day, with older or more active youngsters needing more daily calories and sedentary ones fewer.

The National Cholesterol Education Program Expert Panel on Blood Cholesterol in Children and Adolescents recommends children, beginning at age 2, eat a diet with no more than 30 percent of calories from fat, with under 10 percent from saturated fatty acids, and fewer than 300 milligrams of cholesterol a day.

"The most important thing in countering excess weight is to develop fitness," said Nancy Amy, associate professor of nutrition at UC Berkeley. "Do some activity that's fun -- walk the dog, walk in the mall, go swimming. It's not necessary to do anything really vigorous, but it must be enjoyable: dancing, sports, aerobics, yoga, gardening or just walking up and down the campus."

Even that admonition might seem like a tall order, considering nearly half of 12 to 21 year-olds do not subscribe to any regular fitness regimen.

"Most experts will agree that obesity goes beyond an individual problem," said epidemiologist Peter Katzmarzyk of Queen's University in Kingston, Ontario. "Some would say that we need society changes, and changes in the way that we live at the community level before we will see changes in obesity prevalence."

Some sectors have started bringing to the table a smattering of start-up solutions that smack of a growing appetite for battling underage bulge. A summertime sample includes:

-- Government-sponsored promotions of weight-wise eating and exercise habits, mandates to expand nutritional information on product labels and restaurant menus, programs to promote physical activity among the 6 million American children with disabilities.

-- Federal legislation to restrict child-oriented advertising and on-campus marketing of fat-feeding fare, provide fresh produce to students and direct schools to set standards for food sales and targets for physical activity.

-- State action intended to obstruct obesity, such as a California measure spurning soda-spewing vending machines in elementary and middle schools and a first-in-the-nation requirement, in Arkansas, to provide annual reports tracking body-weight ratios of the state's 450,000 students and offering health-promoting tips to their families.

-- Blueprints by public health, fitness, education, transportation, zoning, government, industry and legal interests for pedestrian- and bicyclist-friendly subdivisions featuring homes, schools, shops, businesses and parks clustered within walking distance.

-- School plans for healthier fare and reinvented physical education courses, as in Rhode Island, where, in a federally funded project, PE teachers from 34 of the state's 37 school districts are training to use step-counting pedometers and monitors to track middle and high school students' activity and fitness levels and devise custom-tailored plans for getting in shape.

"Clearly, physical educators are united in their efforts to attack the obesity epidemic that has surpassed all other forms of preventable disease as the number one killer of Americans," said director Debra Balinger, University of Rhode Island associate professor of physical education and exercise science.

-- Fast-food restaurant downsizing of portions and upscaling of nutritious menu offerings.

-- Industry innovations, such as PepsiCo's introduction Sept. 1 of a Smart Spot program that brands with an eye-catching bright-green logo more than 100 snacks and beverages that meet nutritional criteria for fat, cholesterol, sodium and added sugars.

"We believe the battle is only beginning," said Carolina Jasmin Sapienza, a nutritionist at the Movere Institute for Social Action in Sao Paulo, Brazil.

The main challenge lies ahead, she said.

"We believe that in the long run, only the recognition that nutrition and physical activity must be a part of the daily life of all will help change the direction we are currently going in," said Ted Feder, a clinical psychologist at Movere who has spent a quarter of a century studying childhood obesity.

"Gyms, clinics, even schools are important but only when learning what is healthy nutrition and only when physical activity becomes part of the culture will the 'battle of the bulge' be won," he concluded. "This program includes all of society."


UPI Science News welcomes comments on this series. E-mail

Copyright 2004 by United Press International.


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