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Not too long ago, overweight children were the unenviable "fat kids" in the class, but now portly is closer to the norm. Don't blame the kids, though - obesity experts say adults have to take responsibility for the deadly trend.
"It is child abuse, what we're doing with our kids," said Dr. Neil Barnard of the Physicians Committee for Responsible Medicine.
The percentage of overweight adolescents has tripled since 1980, to 15 percent. This surge comes with changing habits: Only 10 percent of kids walk to school regularly these days. Kids are less likely to play Kick the Can after school than Nintendo. And all too often, students find all manner of junk foods at school to satisfy their sweet teeth.
For some children, gaining weight turns into a medical crisis.
Dr. Stephen Ponder, an endocrinologist in Corpus Christi, Texas, says he has seen thousands of overweight children in the last few years -- including some teens weighing in at 400 and 500 pounds. "We're just scratching the surface," he said. "I couldn't see all of these kids if I saw one a day for the rest of my career."
Type 2 diabetes, an obesity-associated disease once known as adult-onset diabetes, now strikes children, too. Juveniles as young as 5 show signs of heart disease. And doctors worry that Generation XL, so dubbed by the U.S. Surgeon General, will become the first to live shorter lives than their parents. In the short term, severely obese kids feel slightly more socially isolated than young cancer patients in chemotherapy, a recent study found.
Kids' habits, of course, are shaped by the adults in their lives. In a recent survey by the American Council on Fitness and Nutrition, 96 percent of adults said parents were responsible for children's health and weight. But so far, despite years of warnings about obesity as a health problem, parents aren't slimming down their kids -- or themselves for that matter.
American adults, 64 percent of whom are overweight or obese themselves, are not necessarily equipped or motivated to change kids' habits, Barnard said.
"The most responsibility falls to parents, but the problem is parents are never sure where to turn," he said. "Parents for the moment find very little support from schools or government bodies. The things you need to actually help the children just aren't present in our culture."
Are We Doing Enough?
There are some government efforts underway. At least 14 states have introduced legislation this term that would study or change the nutritional content of school meals, according to the National Conference of State Legislatures. At least 15 states have or are currently considering bills to tinker with current physical education requirements.
The federal government, criticized by some anti-obesity activists as being too soft on industry, also is making obesity an issue. Dietary guidelines are being rewritten. Grants worth $13.6 million were handed out this month for local anti-obesity programs. The school lunch program, which has to be renewed by Congress next year, might be changed to mandate healthier fare. And the Senate just approved an increase of $34 million in nutrition and health programs, to nearly $945 million.
Some legislators are working on bills for education about eating disorders, too, concerned that all the focus on obesity could lead more kids to bulimia and anorexia.
But Washington is in the unseemly position of being David to the food industry's Goliath. Approximately $11 billion is spent annually on marketing food -- including the 10,000 food ads the average American child sees each year.
Some educators, doctors and politicians are looking to schools as a key staging area for the fight against fat. Changing what happens at home may be tricky, but controlling the school environment, where kids are a captive audience, is much easier.
Indeed, some of the most promising -- and controversial -- strategies for slimming down the next generation are taking place in the classroom.
In New York City, where 43 percent of elementary school kids are overweight or obese, school officials plan to offer free YMCA memberships and revive intramural sports in the flabbiest neighborhoods.
Arkansas is sending home body-mass index "report cards" to parents, a practice that some school districts have tried, but it's a first for an entire state.
California became the first state to ban soft drink sales to elementary and junior high school students and require school board approval of other junk food vending contracts.
Detroit made school lunches healthier, offering daily fruits and vegetables, calcium-fortified juices, meatless entrées, and whole-grain breads, as well as vegan burgers three times per week.
Boston's mayor wants to teach kids about the empty calories in soda and encourage them to walk to school.
No Exercise, Lots of Doughnuts
These are positive developments to be sure, but they accompany not-so-healthy trends in schools, too. For parents who encourage healthy eating and exercise habits at home, they may find their efforts sabotaged once kids leave for school.
Across the country, physical education classes are being cut to save money and accommodate new federal education standards that emphasize math and literacy. Nationwide, fewer than 30 percent of high-school students have phys ed daily, down from 42 percent in 1991.
And junk food proliferates, in vending machines and cafeterias. Only one school district -- Detroit -- earned a Grade A this year on the Physicians Committee for Responsible Medicine's annual report card of cafeteria fare. The worst lunch lines offer kids' favorite brands of doughnuts, pizza and cheeseburgers.
Even when school districts try to lead the way in fighting fat, school officials can find their actions are not welcomed by all students and parents.
The East Penn School District in Allentown, Pa., was among the first to send home body-mass index information to parents with other health screening information in 2001, after nurses noticed collective weight gain in the student body.
Body-mass index for children and teens is a measurement calculated with height, weight, gender and age. The American Academy of Pediatrics recently recommended the use of BMI measurements as an early gauge of weight problems.
But some parents complained that the "fat letters," as some dubbed the confidential health screening missives, singled out their children.
"We heard: It's none of your business. Since when did you become the fat police? What kind of harm are you doing to the students?" said George Ziolkowski, East Penn's director of pupil personnel services. "We weren't supposed to talk about this, but it is not a cosmetic issue, it's a health issue."
Normal, 20 Years From Now
Some question whether the public schools can and should focus on student health, especially at a time when federal priorities for tight education budgets require strict attention to basic skills like reading.
But Ziolkowski and other health educators say students' physical fitness and academic achievement are closely aligned. "We have health education in schools, it's already there," he said. "We're trying to implement it, enhance it and get people aware that health education goes hand in hand with cognitive development."
Still, some pediatricians question whether schools should measure and send home BMI information. The measurements must be precise, and doctors worry that parents won't know how to interpret the figure.
"Schools are excellent in teaching subjects and passing on information, and doctors are the people who should be measuring BMI," said Dr. Marc Jacobson, a pediatrician at Schneider Children's Hospital in New York.
For Ponder, reversing the dangerous trends he sees in his office every day will require cooperation from everyone who works with and reaches kids, from schools to media.
"Imagine what will be normal in 20 years if something doesn't change," he said. "I don't see any major relief in sight in terms of a medical breakthrough. It's all going to be a public health effort. Let's get proactive."
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