Pediatricians today say
excess weight is now the most common medical condition of
childhood. About 15% of U.S. children and teenagers are
seriously overweight, and 15% more are at risk of becoming
so - three times the rate of a generation ago. This unfortunate
rise in childhood obesity shows no sign of slowing down
and seriously threatens the future health and productivity
of our country. Until now, Americans have been getting healthier
and living longer lives. But new government data shows these
gains are being offset by the growing and widespread prevalence
of obesity. If trends continue where nearly two out of three
adults today are overweight, obesity will overtake smoking
as the leading preventable cause of death among Americans
as early as next year. That means today's children could
face a lifetime of health problems, and for the first time
in many decades, have a shorter life expectancy than their
parents.
The underlying causes of childhood obesity
are varied and complex. A major factor is a lack of physical
activity, caused by a decline in school physical education
programs coupled with an inordinate amount of time spent
sitting in front of computers, TVs and video games. Today's
youth living in sprawling suburbs are driven to school and
after-school activities rather than walking or riding their
bikes. They also have easy access to super-sized, high-calorie
fast-food meals and calorie-laden coffee drinks. They are
the targets of high-profile marketing of unhealthy snack
foods. Besides improper diet and sedentary lifestyles, genetics
also play a role in childhood obesity. So, too, does parental
influence, both in terms of setting examples through healthful
eating and proper exercise, and parenting methods of using
food as rewards for good behaviors. To exacerbate the problem,
obesity is further pronounced in low-income populations.
In fact, a growing body of research shows that people who
have gained the most weight in the last decade tend to have
the lowest incomes, particularly those classified as the
working poor. They have no available time for healthy cooking,
lack the money to buy fresh fruits and vegetables and other
healthy foods, and live far from quality supermarkets with
good, affordable produce sections.
Because of growing evidence that obesity-related
conditions like heart disease, diabetes, some cancers, and
orthopedic problems are taking a serious toll on our country
in terms of deaths, illness, disability and the economic
costs of lost productivity, the U.S. government has begun
taking action. It recently initiated a public service advertising
campaign to persuade people to lose weight and provide more
funding for obesity-related research. Consideration is also
being given to restricting marketing to children, changing
nutrition panels on packaged food, and revising the nation's
dietary guidelines and food pyramid.
Until widespread change occurs, however, local
efforts can have the most impact by getting "in the
trenches" to treat the complex problem of childhood
obesity - one of the most difficult challenges facing children
and teens. Like adults, weight loss efforts in children
have traditionally been only moderately successful. Weight
loss is often attempted with little or no support from health
insurance, the child's family, their school, or their community.
The Family Weight Control Program, offered
through the Section of Adolescent Medicine of The Children's
Hospital at The Cleveland Clinic, is designed to overcome
these known challenges to weight management by involving
parents and families, schools, and the community - all of
which are critical to healthy lifestyle changes and long-term,
successful weight management. Aimed at filling a void in
comprehensive, local services to overweight children and
teens ages 0 to 18 years old, the innovative program embraces
the philosophy that longer, more intense treatment programs
stand the greatest chance of success, and blends a traditional
clinical approach with a community-based component, enhanced
by a research focus to evaluate long-term results.
· Clinical
care. As a continuation and expansion of a program
currently offered at The Cleveland Clinics, patients can
visit a pediatrician for medical care and a pediatric psychologist
for behavioral therapy. They may also be referred to a dietician
for nutritional counseling. To schedule
an evaluation for your child, see your own pediatrician,
or for specialized help, schedule your child for evaluation
of weight concerns with Dr. Ellen Rome, Head of the Section
of Adolescent Medicine, at 216-444-KIDS.
· Support groups.
Based on proven and historically successful national models
that show weight-loss support groups to be effective - particularly
for youth for whom positive peer pressure is particularly
beneficial - this component of the program will encourage
participants to make healthy lifestyle changes that produce
weight loss by teaching them calorie reduction through healthy
food choices and increases in physical activity. Children,
grouped by age and joined by their parents and or/other
caregivers, will attend 10 weekly sessions, followed by
monthly "booster" meetings for a year. Co-led
by a nutritionist, exercise physiologist and a psychologist,
the agenda will include weigh-ins, sharing of advice and
experiences, physical activity, and behavior modification
therapy for overcoming emotional eating and other reasons
for eating too much and exercising too little. Gerard Banez,
Ph.D., is the Director of this Program, called the Family
Weight Management Group. To inquire further, please call
him at 216-445-8658.
· School-based
nutrition education: This arm of the program is in
the planning stages, with partnerships created between the
Cleveland Clinic and the Cleveland Municipal School District.
Our vision is to use the "Food is Knowledge" program,
an innovative program to educate children about math, social
studies, language arts, science, nutrition, art and hospitality
through food and healthy food choices. An example of a lesson
is "Sweet Treats," which introduces children to
fats, oils, and sweets. The lesson emphasizes the importance
of limiting these once-in-a-while treats through the demonstration
of changing solid fat to a liquid and back to a solid. The
students then conduct an experiment on how fats can slow
down or stop blood flow. The lesson ends with the preparation
of a healthy sweet treat, demonstrating how healthy eating
can still be fun. With good luck and good planning, our
hope is to have this program initiated for 4-5 year olds
in fall 2005.
· Museum activities.
Partnering with HealthSpace Cleveland - the former Cleveland
Health Museum - children and their families can participate
in Saturday morning healthy cooking classes and other nutritional
and fitness activities. The programs will be free-of-charge
to low-income participants.
· Summer camp: A
Vision for the Future. This program is in the preliminary
planning stages. With no local options for overweight children,
the innovative Fun 'n Fitness Day Camp would offer an opportunity
for activities without the worries of how they look wearing
a swimsuit or playing a sport, or whether they can keep
up with their physically fit peers. It also could provide
a vehicle for five days of intensive learning and practice
of healthful activities, culminating in a final-day celebration
with family members. The camp offers potential for local
students training in health care professions to engage in
research activities or training.
· Research.
Using the large population of the Cleveland public schools,
along with participants of all aspects of the program, a
patient data registry can be created for long-term outcomes-based
research, to track the correlation over a period of 20 years
or more between weight, medical conditions and healthy lifestyle
changes initiated through our program and any other approaches
recommended by the American Academy of Pediatricians. Eventually,
the program will be a component of The Cleveland Clinic's
translational research activities, examining the role of
genetics in the development of obesity and potential interventions
tailored to specific individuals.
