African American girl refusing vegetables at table

The number of children who are overweight or obese continues to rise. A new study from the Robert Wood Johnson Foundation shows that 15.8 percent of American children ages 10 to 17 have obesity, and in Texas the rate is 18.5 percent.

Black youth had nearly double the rate (22.5 percent) as white youth (12.5).

Here, two health professionals with Texas Children’s Health Plan the Center for Children and Women give insight into childhood obesity and what parents should know: Juliana Baird, a registered and licensed dietician and Dr. Neel Naik, associate medical director.

 Defender: According to the CDC, the percentage of children and adolescents affected by obesity has more than tripled since the 1970s. What do you attribute the increase to?

Juliana Baird:Primarily, the way we live our lives is structured differently. Access to junk foods has increased, everyone is more sedentary, and usually the adults of the family are all working out of the home. This contributes to eating out more frequently, especially at fast food restaurants, and more convenience foods in the home. The frequency of PE in schools has decreased overall; some kids do not have any physical activity at all.

Many children come home after school and spend the majority of time until bedtime on screens. With increased screen time, there is also increased snack time. If screens are not turned off at a certain hour, children also may not go to bed on time and get enough sleep. This may affect hormone balances, stress and emotional health. Access to sugary beverages is also very high.

Dr. Neel Naik:Our busy lifestyles have led us to rely on quick meals that are often unhealthy and with limited time for physical activity. Many times, these quick meals are cheap and therefore tempting to families trying to make ends meet. Also, junk food is so ubiquitous it is easy for children to be surrounded by it and think it is a normal part of our diet. For example, many of my patients think having a daily soda is okay. But the amount of calories in one soda is roughly equal to the calories burned running for 15 minutes! Also, many of my families tell me that there are not safe areas for their children to play outside.

Defender: How do health professionals determine if a child is obese or overweight?

Baird:This is determined officially by BMI (body mass index). Overweight is defined on the CDC 2-20 charts as BMI 85th to 94.9thpercentile for age. Obesity is defined as BMI 95th or greater percentile for age. BMI is not a perfect tool, though, as some people who carry a large amount of muscle, such as football players or weight lifters, could have a high body weight but be very healthy. This is just a starting point to begin looking in to lab values and the patient’s habits. Often, if cholesterol or blood sugar is high, the weight is elevated due to food choices and inadequate physical activity.

Naik:There are many online calculators that you can use to determine your BMI. I recommend everyone try it, you might be surprised. Elevated BMI can be associated with heart disease, high blood pressure, Type 2 diabetes, and certain cancers.

Defender: How do they decide which weight loss program is best for a child?

Baird: In general, diets don’t work. If they did, then no one would be looking for the next fad. Most popular diets are very restrictive, usually eliminating one or more food groups, and therefore are not sustainable. Once a person stops the diet, then they go back to previous habits and regain the weight. Children also are growing and need to have a wide variety of healthy foods to obtain adequate nutrients.

In our clinic, patients are referred to meet individually with a registered dietitian for assessment of each person’s needs. The dietitian spends an hour at the initial appointment understanding the current habits and lifestyle of the child and family. The goal is to help the patient and family make a lifestyle change and learn how to make healthy choices, rather than a short-term diet.

Together, the family and the dietitian create a few goals to work toward for the next month. The family can also participate in classes provided at our clinic, including a cooking class offered twice a month and a combination nutrition and exercise class offered weekly. The people who are most successful are just consistent; they focus on one or two manageable changes at a time that can be sustained permanently. We want everyone to have a healthy relationship with food, exercise and body image.

Defender: What is the most effective weight loss program or plan for children and teens?

Baird:There is no specific diet or weight loss program that is used. Patients are most successful when they have a foundational understanding of how to make healthy choices on a daily basis. The choices people make on a daily basis make the biggest difference, rather than occasional indulging at a special event. Portion sizes, balance of food groups on the plate, beverage choices, amount of physical activity, and types of snacks are all choices that accumulate over days, and weeks, and months, and years to make a big impact on one’s health.

Any person trying to make a change needs support from family and friends. The whole family needs to change habits together. Everyone will benefit from more water, less sugary beverages, more fruits and vegetables, and less processed foods. Everyone needs daily physical activity.

Frequently, we use the Plate Method as a tool for making choices about portion sizes and the balance of food groups. Each section would be proportional to the person’s fist size. Younger children seem to enjoy this visual and comparing their hands to the rest of the family. We also use the “Go, Slow, and Whoa,” method of identifying how often different foods should be eaten.

For example, “Go” foods are not limited other than balancing them on the plate with other groups. “Slow” foods would be limited to three per day, while “Whoa” foods would be limited to one to two times per week. Most kids can easily start to sort foods into those different categories and learn why a whole fruit would be a better choice than a juice. This allows them to have some control over what foods they choose, but to have an awareness of how to choose healthier items.

We want patients to learn the skills to make their own decisions in many situations, versus following a restrictive diet. With everyone, we try to find their own individual source of motivation to change. Teens sometimes are resistant to change, and since they have so much control over their own habits compared to younger children, finding motivation can be difficult.

However, some teens are very motivated by a new awareness of health and can understand health in longer terms, such as preventing heart disease, diabetes or cancer. The biggest influence we see on whether a patient changes habits or not is the value a family places on health. If the parents value health and create a family culture focused on making the best choices possible, then children and teens are much more likely to value health and make good choices too.

Naik:The most effective diet is when the whole family is involved. Children may not listen to you, but they will follow your actions. As a pediatrician I can offer advice to my patients, but if the parents keep excessive soda, and junk food at home, and the parents do not exercise, the child will not either. The apple does not fall far from the tree. If the parent wants best for their child’s health, they must also practice healthy nutrition themselves. Be strict about limiting junk food, exercise together as a family, and keep healthy foods within reach around the house for snacking – trail mix, fruit, water, etc. Most importantly cook together as a family. Cooking at home often is healthier than eating out, and when children help cook, they feel proud of what they have made, and are more likely to eat it.

Defender: Does treating an obese or overweight child differ from treating an adult?

Baird:Children are more subject to the effects of their environment. If a parent is buying junk foods for the house that are easily available to the child, then avoiding those tempting foods may be very difficult for a young child. If a parent does not have time to go to the park or spend time outside after school, then the child most likely is not going to find a way to exercise independently.

Naik: Not really. It all comes down to calories in (eating) and calories out (activity). However, children often may not understand fully the implications of a poor diet. For older children/teenagers, it is a good idea to ask the child what goals they would like to set for themselves. This makes the child feel involved in the process and usually better outcomes.