Growing up too fat

Twenty percent of American children are overweight. An expert offers advice on how to talk to your kids about their weight, why diets don't work and what society needs to do.

By Katharine Mieszkowski

Apr 16, 2005 | Why do more and more kids in the U.S. have pudgy paunches bulging over the tops of their low-rider jeans? When it comes to the much-publicized childhood obesity epidemic, everyone has a pet theory.

With today's super-sized fast food portions, kids pack it in by the fistful of fries and 20-ounce Coke. More meals at home consist of takeout or precooked ready-made fare, loaded with fat and calories. TV and video games have vanquished running around outside. Kids in the city have too few safe places to play. And kids in the suburbs have no sidewalks to walk on, much less places to walk to. Fewer kids walk or ride their bikes to school, either because there's no safe route, or it's simply too far. At school, phys ed and recess have been shortened or eliminated, through the double whammy of budget cuts and renewed emphasis on academic testing. And many schools sell junk food to kids in the cafeteria in an attempt to subsidize shrinking budgets through soft drink and candy bar revenue.

Even "Sesame Street's" Cookie Monster, that shameless calorie-hound, is drawing suspicion. This season, the beloved blue glutton will learn to scarf fewer cookies so he can be a role model for healthier eating habits.

No one really knows which of these concurrent factors has had the single biggest impact on kids' widening waistlines, but it all adds up to a country where about 20 percent of children are overweight. Epidemiologists at the Centers for Disease Control and Prevention estimate that if the obesity epidemic continues, 30 percent of boys and 40 percent of girls born in the U.S. in 2000 will have diabetes at some point in their lives. And this generation of American kids will be the first in 200 years to have a shorter life expectancy than their parents, according to a controversial new study published last month in the New England Journal of Medicine. The study found that today's kids may shed as many as five years off their life.

In "Fed Up! Winning the War Against Childhood Obesity," Dr. Susan Okie, a family physician and medical journalist, argues that even as doctors continue to research the myriad causes of the super-sizing of American kids there's a lot that parents and society can do to fight back. A contributing editor for the New England Journal of Medicine, Okie, who worked for many years at the Washington Post, spoke with Salon about what can be done to help today's fat kids -- and why even an obese child should never be put on a diet.

Do you think that a misplaced fear of giving a kids an eating disorder or a lifelong complex about food keeps parents from trying to change their children's weight or bad eating habits?

For a long time the pediatric community really worried about focusing on how much food children ate because they were afraid that kids who had the potential to become obsessive about food might end up with an eating disorder.

But have parents internalized that message as well?

I think that parents of girls may have. There's been a lot in the press over the years about eating disorders and girls, but it's a fairly rare thing. It's almost unheard of in black girls, and it's fairly rare in white girls. But it gets a lot of press and parents worry about it.

But obesity is common. It's not that you want children to learn to count calories or become obsessive. But society has become unable to figure out what an adequate portion size is because there has been so much super-sizing in restaurants and in the grocery stores. And even at home people tend to serve larger portions than they need. Just learning reasonable quantities is an important thing to do in order to try to reverse the obesity epidemic.

How should a parent talk to a fat kid about the child's weight?

It may be easiest for the parents to bring the child to the pediatrician, and have that conversation with the pediatrician there.

The point is to impress on the child that it is a health issue. It's not that there is something wrong with the child's body, or that the child is doing something wrong. If the parents have a similar issue, or did when they were children, they should say something like: "I've struggled with this myself. The reason that I'm concerned about your weight, and your doctor is concerned, is that we want you to be healthy, and we want you to have a long life. There's a problem with weighing too much. Having too much fat can put you at risk of developing some health problems. And we want you to grow up healthy and strong, and able to do all the things that you want to do."

Focus on the fact that it's a health issue. It's not a beauty issue, or a glamour issue, or anything like that. And emphasize that this is a problem that you're going to help the child with.

But what if your child is not overweight, and you're trying to prevent him or her from becoming fat?

You would take a somewhat similar tack, and say: "In our family, we're all going to try to eat healthy and do the things that are good for our bodies. And the reason that we buy certain foods and not others is because we all want to stay as healthy as we can. We want to try to make good food choices so our bodies can do the things that we want them to do. So you can play and be strong."

So, that's why you can't have the Cocoa Puffs?

"That's why we don't buy the Cocoa Puffs. We're trying to make you stronger and healthier."

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