In 1857, Mount St. Helens—in what would later become the state of Washington—settled down after several years of eruptions. For the next 123 years, not a peep was heard from one of the largest volcanoes in the world.
It began to reawaken in March 1980 with daily earthquakes and steam plumes, indicating that a dangerous eruption was possible. Over the next two months, the mountain began to deform, a massive bulge forming on its north face. Scientists suspected a catastrophic explosion was imminent. Local residents were lulled into a false sense of security when the mountain quieted a bit in early May.
On the morning of May 18, Mount St. Helens erupted violently. Pressure blew off the top 1,000 feet of the volcano, with deadly results. Fifty-seven people died that day, most because they failed to heed the warnings of forestry officials.
There was no need for anyone to have been hurt. Some victims had thought officials were being overcautious. Some, like famous area resident Harry Truman, simply refused to leave.
Today, many nations are feeling tremors and seeing steam plumes as the “obesity volcano” rumbles. While the Mount St. Helens blast was unpreventable, we may be able to avoid a worse disaster—an explosion of obesity-related disease.
Many a doctor has noticed increasing numbers of obese children and adults walking through the office door. What physicians have been observing anecdotally for years has now been proven statistically: Obesity rates are steadily rising. Ultimately, this epidemic is likely to contribute to thousands—if not millions—of premature deaths.
How did this happen? Here are some of the reasons. Taken together, they weave quite a tapestry.
If you’re over 35, you may recall childhood summers when you left the house after breakfast and were outside all day, stopping only briefly to use the bathroom and eat a quick lunch. Maybe you’d ride all over town on your bike, play ball with a few friends for hours on end, go to the pool, or collect crayfish at the local stream.
In those days, unorganized neighborhood games of baseball, basketball, street football, kickball, or Capture the Flag took place daily. According to my mom, as a young child I frequently fell asleep at the dinner table—sometimes with my head literally landing in my food—after running around outside all day long. Free of constant parental oversight and organization, kids improvised and played for the fun of it, without pressure.
Today, too many “organized” sports and other activities, especially for younger children, may be robbing kids of the joy of spontaneous games and competition and playing alone. In some places, unsupervised play is simply no longer possible. Legitimate fears of abduction and crime have curtailed much of the freedom children used to have. In certain urban and suburban locations, dangers posed by street gangs force parents to keep their kids inside.
Many parents drive their children everywhere, since it’s too far or too dangerous for them to ride their bikes or walk. Fear of litigation has caused many schools and municipalities to remove playground equipment. The bottom line: Children are moving less these days, thus burning fewer calories.
“Super-Size it, please!” is the command from the “drive-thru” customer to the fast food employee. What’s next, Super-Duper Size? Mega-Super-Duper Size (labeled “Best Value,” of course)?
In our culture, we like to feel we’re getting our money’s worth, and expect things big—especially meal portions. Where else can you get a steak that could feed a small town or a restaurant dessert roughly the size of a toaster?
In France, where people tend to eat a relatively high-fat diet and are avid wine drinkers, the obesity rate is lower—partly because they eat smaller portions at mealtime and do so at a leisurely speed. While I don’t advocate the secularist French way of life, the pace and enjoyment of eating there is commendable. Our society’s “Texas-size” eating mentality is no doubt affecting many of our children—and not for the better.
We’re reaping what we’ve sown—God’s timeless principle. If we can return to modest portion sizes and slower eating, we can begin to have a positive effect on our children’s dietary habits. The result: less obesity.
As school administrators try to maximize children’s academic performance and squeeze precious minutes out of each day, time spent in physical education courses is often reduced. This may not matter for children living in active families, but the rest are missing out on a way to learn how to be physically fit.
Fortunately, some schools are now increasing time spent in P.E.— an encouraging development.
I admit it: I love my Macintosh laptop computer. I also love watching sports on television. Though I’m not into video games, I’ve observed patients in my office playing them—and it takes considerable effort to get their attention away from those little electronic marvels.
We live in a digital age, and new avenues of entertainment are only going to proliferate. It’s clear, however, that the amount of time spent daily in these pursuits can be directly correlated with childhood obesity rates. Why? Because of inactivity and the powerful effects of food product advertising on TV.
Children’s shows are especially laden with food commercials, and I’m not talking about fruits and vegetables. Our marketing gurus are no slouches; they know that a slick ad can seduce us into getting up for a snack halfway through a football game, TV movie, or cartoon. Couple this with the fact that many of the advertised foods and beverages are high in unhealthy fat and sugar (see Chapters 5 and 6) and you’ve just added another brick to the wall of our epidemic.
Many pediatricians recommend an upper limit of about two hours of TV/video/computer time per day, but a lot of our children greatly exceed that limit. Kids would be much better off with little or no time on the TV, video game system, and computer—and TV is by far the worst of the three because of food advertising. In fact, allowing children to have televisions in their bedrooms is directly tied to increased TV watching and obesity.
I can sense the uneasiness as you shift nervously in your seat, preparing for a soapbox lecture. Not to worry. I simply want you to know the facts, and the evidence is clear that families who sit and eat together on a regular basis have lower obesity rates.
This makes perfect sense. More conversation, eating more slowly, consuming fewer meals at fast food establishments, serving normal portion sizes—all would contribute to a smaller total calorie consumption at mealtime. Interestingly, this benefit seems to lessen considerably if the family watches television during the meal.
Years ago, people walked to the market daily and bought the food they needed. There was less food around the house; more fresh fruits, vegetables, and whole grains were consumed. An elderly gentleman once told me, “We Americans need to mimic classic Europeans in one thing—we should shop at the market daily and watch TV weekly, instead of the other way around.” Sound advice, indeed.
Suburbanization has made this largely impractical. Our kids are walking much less than previous generations. Cars have replaced feet and bicycles as the primary means of transportation.
Are residents of cities and those who live near a town center leaner? The answer isn’t simple. When I traveled to London a few years ago, I was taken aback by the apparent lack of obesity. The streets are so crowded that Londoners have to be crazy to drive anywhere, and the “tube” system of underground trains can whisk you anywhere in minutes. Thus, residents walk quite a bit and rely less on automobiles.
While this may account for the seeming lack of obesity in London, it doesn’t provide easy answers for everyone. Recent information in the U.S., for example, suggests that obesity rates there may be tied to the affluence of certain areas. The more affluent the area, the less obesity.
This also makes sense. It’s more expensive to eat properly; fresh fruits, vegetables, and fish are more costly than canned and processed foods. People with more wealth also tend to be more educated about nutrition and exercise and have easier access to health clubs.
In times past, it was a sign of wealth to be overweight and a mark of poverty to be lean. Today the reverse is true. Poor children are at greatest risk of obesity, and we need to address this fact. Combine that with the trend toward more mechanized transportation and less walking, and you have a direction that needs to be reversed.
I’ve observed—though only anecdotally—that obesity seems more common in children of divorced parents than in those whose parents have stayed together. And more children are growing up in families affected by divorce than in the past. This is consistent with the finding that poorer children are more prone to obesity, as divorce places severe financial strains on a family.
It’s easy to underestimate the effect of divorce on a child. But the loneliness, depression, and other psychosocial factors that often come with divorce can lead to abnormal eating patterns. Many adults and children eat as a way of soothing themselves; food becomes the one comfort they have in life. Stress may also cause an increase in certain hormones, which can lead to cravings.
It’s also logistically much harder for divorced parents to coordinate a healthy eating plan if they have dual custody of a child. The parent who sees a child only on weekends may inadvertently spoil that child by going out regularly to eat more “fun” foods. Many divorced dads lack the knowledge or desire to cook proper meals, and it’s often easier to buy fast food.
This is not to say that children of divorce can’t overcome weight problems. But it’s going to be tougher than usual and requires a high degree of cooperation between parents. With all the challenges facing fractured families, implementing the changes necessary for a child to conquer weight problems can be one very difficult proposition.
I’ve seen this often in my practice. Broaching the topic of obesity, however gingerly, elicits looks of fear on some parents’ faces. Several have let me know that they’re afraid their children might swing back the other way toward anorexia nervosa. This happens mainly in parents of overweight or mildly obese girls.
Gradual reduction toward a normal weight is not a risk factor for anorexia. Though anorexia is possible, the risk is very small. Don’t let this concern stop you from helping your child lose weight. If you feel body image distortions are developing, contact your doctor immediately.
Many families have aunts, uncles, grandpas, grandmas, and nannies watch the children while parents work. These caretakers’ opinions about a child’s weight may differ from the parents’ view. “Doctor, he is so skinny!” is a phrase I often hear from grandmothers, despite evidence that the child is growing normally or is even a bit heavy.
I remember a particularly insistent grandmother who, when I said it was normal to see the outline of her six-year-old grandson’s ribs, looked at me incredulously. “You can’t be serious!” she retorted, obviously wondering if her grandson was under the care of a quack. I was able to dissuade her of that sentiment, but the encounter illustrates a problem doctors often face.
Cultural factors also play a role, causing varied expectations about a child’s appearance and food consumption. This can be tough to overcome, and requires a physician to earn the family’s complete trust. Clear communication is crucial, too, and any hint of a dictatorial attitude by the doctor may sabotage the process—convincing parents not to comply with recommendations.
Children growing up in a home with one or two obese parents are at higher risk for obesity. With more and more parents overweight, more and more children are being raised in these households and imitating parental behavior.
Overweight parents may find it difficult to discuss weight problems with a child, fearing they’ll look hypocritical. As with smoking parents who counsel their kids not to take that first puff, this can be tricky.
If you’re in this situation, acknowledge that both you and your child have slipped into bad habits—and then correct them together. At the very least, explain the dangers of excess pounds and fully support your child’s efforts to lose them.
Are genetics a contributing factor when parent and child are overweight? They can be, but that effect may be overblown. Genes are unlikely to account for the steep increases in obesity rates. Most obese families are the direct result of poor eating and exercise habits developed and passed down through the years. At present we can only control diet and exercise, so it’s not helpful to dwell on heredity.
This doesn’t mean that genetics have no influence on weight. Recent studies have described the effect of genetic mutations on appetite control.1 One example involves an appetite suppression gene. The Melanocortin 4 Receptor (MC4R) works in the hypothalamus of the brain to suppress appetite. The most common mutation, a deficiency of this MC4R gene, occurs in about 6 percent of severely obese children. They have less MC4R, leading to poor appetite control. All these children have markedly increased insulin levels in their blood, which can aid in distinguishing them from other obese children without the mutation.
Future research may identify ways to help these children with medication or gene therapy. (Note: The test for this mutation is not presently available commercially.)
Published in 1992 by the U.S. Department of Agriculture, the original Food Pyramid was merely an extension of dietary teaching that began in the 1960s. The premise seemed correct: Limit fats and increase grains and vegetables. The problem was that no distinction was made between “good” and “bad” carbohydrates and “good” and “bad” fats.
The lower part of the pyramid consisted of bread, cereal, rice, and pasta; six to eleven servings a day were recommended. As we’ll see later in this book, someone could follow this guideline perfectly and be eating poorly. A diet of low-fiber bread, breakfast cereals, rice, and pasta may conform to the pyramid but contains way too many simple, processed carbohydrates. Eating this way can lead to excess weight gain, and it will be of little consolation that the child is eating a “low fat” diet. We need to get back to eating unprocessed grains, high fiber cereals, and whole grain pasta.
Contrary to the impression given by the pyramid, not all foods with higher fat content are bad. Nuts and vegetable oils are perched at the top of the diagram, with no distinction made between very healthy nuts and oils, high in monounsaturated fats, and saturated fats that are unhealthy. The implication is that nuts and oils aren’t good for you because they’re high in fat. This is simply not true. While they’re calorie dense, nuts and certain oils (especially olive oil) should be a significant part of everyone’s diet. They’re packed with hearthealthy fat—no, that’s not a misprint—plus nutrients and calories for energy. They help you feel satisfied and can squelch hunger pangs and cravings, aiding a decrease in snacking.
The pyramid also places legumes (like beans) and fish in the same category as red meats. This is also just plain wrong. Legumes are a fantastic source of protein and fiber without the saturated fat of meat. Certain types of fish, high in omega-3 fatty acids, are very wholesome and should be afforded higher priority than red meat.
As you can see, good intentions often don’t accomplish their goals—and may be counterproductive. Recently changes were made to the original pyramid—but the result, in my opinion, is even more confusing than before. I’ll have more to say about carbohydrates, fats, and the basics of nutrition later in this book.
These are the main reasons why our kids are becoming heavier and heavier. You may be able to think of a few more.
Who’s responsible for this fix? There’s plenty of blame to go around. Government has promoted the misleading Food Pyramid and taken on tasks that belong to parents (feeding their kids, for instance). Physicians have long been lackadaisical in addressing the problem of obesity. Schools have done a poor job by offering less-than-healthy cafeteria fare and allowing soda pop and snack machines on campus. Corporations market junk food to make a buck, supplying products to meet a demand—even if the demand is unhealthy.
Parents bear primary culpability, for they are ultimately accountable for their children’s health. In Ephesians 6:4, God does not say, “You villages, governments, and schools, bring your children up in the training and admonition of the Lord.” No, He addresses fathers.
Eventually children will have to assume care of themselves, but until that time arrives, parents need to be role models, teachers, disciplinarians, and loving advocates. Once kids reach age 12 or so, they may unwisely reject your recommendations or make things extremely frustrating for you. At some point they must sink or swim on their own. This is why it’s so crucial to instill good habits at an early age. Children imitate their parents and learn from them. What example are you setting?
While there may be genetic factors involved in appetite and body type, obesity is ultimately an issue of individual responsibility once a person is over age 12 or so. Remember, we’re talking about obese children and adults, not simply bigger people with a tendency to be heavy. Some folks may have a genetic tendency toward other types of addictions; they must take control of their own destiny to conquer the problem. The same is true of those who are obese.
There’s no question that the process is made easier when a parent, friend, or organization supports and provides information to and encourages the person. But the buck stops with the individual. If obese adults wish to lose weight and get into shape, they have to be the ones to follow through. Deciding what percentage of the problem can be traced to genetics is academic. Many obese people have said to themselves, “Enough is enough,” and transformed their lives. They may have languished for years, mired in a terrible diet and inactivity, only to turn things around with knowledge and resolve. They didn’t simply “diet,” but instituted wholesale lifestyle changes. I know they’d tell you it was well worth the effort.
Children are unable to take on many of these responsibilities, being dependent on their parents. They need you to engage them in these lifestyle changes.
Talk of obesity as a disease is, in my opinion, misguided. In many cases this designation shifts the focus from the responsibility of parents and kids, implying an intrinsic abnormality. But we’re talking about exogenous or common obesity, not a hormonal imbalance.
Obesity is really a symptom of a larger problem—compulsive overeating, lack of exercise, depression, etc. Like cigarette smoking or excessive drinking, obesity can cause disease, but is not a disease in itself. Individuals must be willing to do what it takes to regain their proper shape.
It’s human nature to look for someone else to blame when things go awry. Recently, threats of litigation have been aimed at the fast food industry for “causing” obesity. Most of us realize that fast food menus are full of awful things, and wouldn’t serve them at home, let alone sell them to others. I believe most ordinary, rational people view these lawsuits as ludicrous, and understand that financial motives may be partially driving those voicing the threats.
Distancing ourselves from the never-ending blame game aids us in squarely facing the problem of obesity. God wants us to take responsibility for ourselves and quit passing the buck. Parents must be accountable for their children just as adults are accountable for themselves.
There are many reasons why obesity rates have risen sharply in the last two decades. Each of the factors listed in this chapter must be evaluated and dealt with if there’s to be success in curbing abnormal weight gain.
Parents need to patiently take charge of their children’s nutrition and exercise routines. It won’t be easy, and you may have failed in the past. But be persistent and get help from your friends, family, pastor, and doctor.
In a later section, I’ll outline a program for helping your child stay slim and fit—or to begin overcoming obesity and unfitness. In the meantime, let’s find out why your efforts to raise fit kids could be a matter of life and death.