Weight Of The Nation Is 'Out Of Control' So What Can Parents Do?

http://www.youtube.com/watch?v=SY2hnVGZ_vk

A new HBO documentary that is really more of a desperate public health plea aims to shock viewers off their couches and away from their sugary sodas in order to reverse a raging national obesity epidemic among children and adults. "Obesity will crush the United States in oblivion," notes one Texas official, echoing the mood of impending disaster that permeates the series, "The Weight of the Nation."

At the House of Blues in Boston last night, various public health officials came together to screen one segment of the show: Part three, which focuses on "Children in Crisis" and the alarming number of obese kids in the country. The series takes a hard look at the challenges — from high cholesterol and fatty liver to intense bullying and social stigma — these kids and their parents face.

I spoke with Elsie Taveras, MD, MPH, who is featured in the film and is director of the One Step Ahead clinic, a multidisciplinary childhood overweight prevention and early management program at Children's Hospital Boston.

Dr. Taveras sees children who are already suffering the effects of obesity. In the film she examines kids with dark rings around their necks, an early sign of insulin resistance. Her patients have signs of pre-diabetes; they have high blood pressure; and some of her 7-and-8-year-olds have adult levels of high cholesterol.

"I've started seeing fatty liver," she says, a condition more typically associated with cirrhosis. "The other silent co-morbidity is mental health," she says. "The teasing can be vicious, cruel. I can't tell you how much of that we hear. These children are depressed, they go through life being on the defensive, knowing some comment is going to come at them at any moment."

I asked her about the extreme parenting that seems to be required these days to protect our kids from this fate. How do we nudge them to stay active, healthy and aware of what kind of foods are good for their bodies without turning them into raging neurotics with eating disorders? Here's our short, edited Q & A.

Dr. Taveras: It's true, you have to go out of your way to counter so many influences and forces pushing against your children. Even if you do the best that you can at home, things are working against you — the constant advertising on all the screens — you have to really work hard these days to not let your kids become obese...

My husband sometimes said, 'Why not let the kids have Lucky Charms once in a while,' but after he saw the film, he was struck — the food advertising was the most powerful thing for him.

RZ: So what can parents realistically do?

ET: I actually think there are a few things that if we did consistently, would make a huge difference and we wouldn't have to go to extreme parenting.

The first is to limit exposure to food advertising. We know from all the evidence this vicious advertising to children has a big impact.

Next is stopping all forms of sugary beverages. Eliminate all sodas, and limit all other sugary beverages as much as possible ...and only have one 4-or 6-ounce cup of juice a couple of times a week. (Dr. Taveras keeps no juice in her house, she says, and her kids drink only water and milk. She says her most successful patients are the kids who can eliminate the sugar-laden drinks from their diets.)

RZ: The next is...

ET: Physical activity, every day. And I'd like to debunk this myth that it needs to be structured, all you need is to take the kids to the park, get them a bike, you don't need any kind of membership. This doesn't have to be expensive. My reality check is, what can I recommend that will be feasible to my families in Dorchester? (Her clinic, based at the Children's Hospital Primary Care Center, serves low-income, inner city kids under 13.)

RZ: But you don't want to be too crazy, like that mom who put her daughter on the incredibly strict diet and policed every bite.

ET: Right, if we are way too strict in restricting our kids, we're going to drive them to the opposite extreme. I'm not putting kids on diets, we are teaching them about once-in-a-while foods, everyday foods...dieting backfires. I really do think we're not talking about huge changes. I wish I could just get these parents early and tell them what to do. Treatment is so much harder than prevention.

And finally, she says, it's important to engage parents as well as kids. "Its always the unspoken truth in the room," she says. "There are common exposures — the same things contributing to the kids being overweight are also contributing to parents' weight. But this is out of the comfort zone of many pediatricians — for them to go there is very uncomfortable. But the reality is, for many of these families, it's a household issue."