Dr. Charles Attwood, a pediatrician who has written extensively on preventative medicine and children's nutrition, tells us that arteriosclerosis, or the gradual blocking of the coronary arteries, has its roots in childhood eating habits. The steadily increasing consumption of saturated animal fats - such as those found in beef, pork, chicken, milk and cheese - causes half a million deaths per year. He contends that if it were any other disease that was so prevalent, the public would be aghast and would employ strategies to prevent or cure it. But not so with problems involving eating habits. These are more deeply ingrained, and it is difficult to convince people that lifestyle changes may in fact improve their lives and the lives of their children.

Although there is no standard definition of what is considered overweight in children, for preschool age and older, it is generally thought to be a body weight 20% or more above the normal weight for height or a body mass index (BMI) at the 85th percentile or above. Those whose BMI is at the 95th percentile or higher are sometimes called superobese. Using the BMI definition, 10% of all preschoolers are overweight, more than 20% of elementary age children in the U.S. are significantly overweight, and more than 10% are superobese. In Italy, 23.4% of a sample of 10-year-old boys and 12.7% of girls were obese, while Canadian researchers report rates of roughly 20%. Obesity is more common among Hispanic and African Americans than Caucasians, with the highest rates among Mexican Americans. These ethnic differences are really poverty differences. Among poor children, obesity is more common because it is cheaper to purchase high fat, high calorie foods than fruits and vegetables. (The Growing Child)

The prevalence of obesity has risen drastically in the past several decades. Although some estimate that obesity affects nearly 30% of children, the condition often goes underdiagnosed and undertreated. Hormonal and genetic factors are rarely the cause of childhood obesity. (American Family Physician)

Heavier children tend to reach puberty sooner, and for girls, that results in a greater risk of breast cancer as adults. Type II diabetes, or adult onset diabetes, is now being seen not only in adults, but in teens, preteens, and even younger children according to the American Diabetes Association statistics. (Parenting October 2001)

Obesity is a problem because obese children are at a higher risk of being obese adults. Obese adults have a shorter life expectancy, higher risk of heart disease, high blood pressure, diabetes, gall bladder disease, some forms of cancer, and respiratory problems. Adults who are obese have extreme difficulty controlling their weight, and few treatments offer realistic solutions. Through chronic disease, it is estimated that obesity kills about 300,000 Americans a year. (Parenting October 2001)

Obesity causes social problems for children as well. In one study, young children were asked to describe a silhouette of a fat child. They chose the words lazy, dirty, stupid, ugly, cheats, and liars. Simply stated, overweight children are targets for ridicule. They can not keep up with their peers on the playground, having difficulty even doing the simplest of physical activities. They are often isolated, leading to low self-esteem and depression. Obesity is a condition with both long-term physical and social consequences.

Prevention is the greatest hope we have for decreasing the prevalence of obesity in adulthood. That means beginning with our children but also looking at ourselves and our own eating habits. What is our fat intake? Do we snack on fruits and vegetables or sugary sweets? Do we exercise and move or sit in front of our computers and televisions? Preventing obesity means looking not only at our children but our family's habits as well.

Why are some children overweight?

When I was of school age and asking my father for a ride anywhere, he would recount the story of how when he was a boy, he would to walk nearly two miles to school every day in northern New England, braving the elements and putting potatoes in his pockets just to keep his hands warm. I don't know if that story is true or not, but the message is important-if you can walk, don't ride. Television and personal computers have become favorite pastimes for too many children and with them the emergence of a sedentary lifestyle. Children are less active than they were in the past, being driven places and sitting mesmerized for long periods of time. In order to prevent weight gain and remain in overall good health, exercise is imperative.

The average school child in the U.S. eats a diet too high in fat and too low in fruits, vegetables and whole grains (The Growing Child). Three in 10 school age children eat less than one serving of fruits and vegetables per day, not counting fried vegetables such as French fries. School lunches are typically very high in fat, averaging about 33% of calories from fat, 12% from saturated fat. The USDA regulates that whole milk must be offered, which add to the fat content of the meal. (The Growing Child)

Snacks for young children not only are bigger in portion size, they contain more calories than they did twenty years ago. Families eat out in restaurants more than ever before to accommodate busy lives. Today, most eateries serve portions that are larger and laden with more fat than in the past. Soft drink and fruit beverage consumption has nearly doubled in the past twenty years. In one study of middle school children, those who had at least one sugar sweetened soft drink a day tended to be overweight. (Parenting October 2001)

There is a genetic component to being obese. But whether or not children who are genetically predisposed to be heavy will become obese still depends on the balance between the number of calories consumed and the number expended in exercise.

Preventing Obesity:

The obese adult who was once the overweight child faces an unlikely long-term success at maintaining proper weight. If we are to have a healthier adult population we must lay the groundwork from birth on. Some tips for maintaining healthy weight in children are:

Begin at the beginning

--If you do not eat healthfully, then begin to when you plan to conceive or when you become pregnant. Recent studies have shown that babies prefer the foods that their mothers eat both while they are pregnant and while breastfeeding. So rather than bulking up on junk food, begin good habits (that will last a long time) before your baby is even born.

Monitor growth and development

--Pay attention to your child's growth patterns as part of their regular well child visits with their pediatrician. One warning sign is a change in growth pattern where the weight percentile far exceeds that of the height percentile. This is especially important if there is a family history of being overweight.

Choose snacks wisely

--As babies grow into preschoolers, make sure they snack on low fat, healthy foods, establishing life long healthy eating habits. Healthy high fat snacks, such as peanut butter, can be included in the diet, but try stretching the peanut butter with bananas or cooked mashed sweet potato and some honey. Your child will continue to get the protein boost without all the fat.

Limit fat and sugar intake

--An ideal diet has no fat restriction for children under 2 years; 25-30% fat for children over 2 years; This number can decrease as the child gets older, but generally not lower than 15% unless there is a medical problem. According to pediatrician Dr. Attwood, an even lower intake of fat is ideal. There is not a consensus about the ideal fat level for children, but there are ways to reduce fat intake. Eliminating animal products and replacing them with healthier choices of legumes, grains, fruits, and veggies will allow you to keep within this framework. Whole milk should not be given to children after age 2. Note: Soymilk's fat is already like that of reduced fat milk. Parents should not use lowfat soymilk for children unless the rest of the diet is very high in fat. Offer kid-sized servings, and never demand a child finish everything on the plate. Limit daily amounts of fruit juice for kids ages 1-6 years to between four and six ounces. (American Academy of Pediatrics)

Burn more than you chew

--Turn off the TV and the computer. Put down the Game Boy. Be active. A fundamental law of weight control is burning more calories than you consume. Encourage your children to do activities other than sit at the computer and watch television. Park at the end of the parking lot at the grocery store and walk the extra distance. Exercise regularly, making physical activity a regular part of your day. Walking, swimming, hiking, dancing, and biking are all excellent ways to keep your body in shape.

Follow me

--Model good eating habits. No child will request fruits and veggies if you are eating high fat foods. Empty your house of temptations and keep only healthy foods around. Eat the way you want your children to eat. Healthy habits must be a family affair to be effective. Don't use food as a bribe for good behavior or promise dessert if a meal is eaten entirely. Children need to learn to judge for themselves when they are full. Use praise and attention or other non-calorie reinforcements as rewards.

Make mealtime family time

--Are family dinners stressful or hurried? Make time for at least one quiet, slow-paced meal per day together as a family. Talk about the day or tell great stories. Involve children in the preparation of healthy foods. Talk about how food grows, and experiment with new healthy recipes or reinvent old favorites with a healthy twist.

Go to the source

--Buy as much of your food as close to the source as possible, picking fresh produce in season or shopping farmer's markets to teach children the origins of food. Plant a garden in your yard or an herb garden on your windowsill. Become a member of a community supported agriculture farm. When children learn at a young age to appreciate the origins of earth-grown food, they value it more and enjoy partaking of it.

Talk up healthy eating

--After reading the book, "Bread and Jam for Frances," my son and I had a wonderful discussion of what happens when you eat the same thing that is not that good for you over and over. In the book, Frances wants each meal to be bread and jam but finds after a few days that she isn't feeling very well. He now understands why we vary what we eat to keep our bodies strong and healthy. He knows he heals quickly from cuts because his body is so capable and he rarely gets sick for similar reasons. At just three, he had a basic understanding that eating well means feeling well.

Conclusion:

Some believe that conquering obesity will require an all-out universal uprising that will lead to a public education effort similar to the campaign against cigarette smoking in the United States. Are we as a collective people ready to examine and change eating habits that were established at such early ages? Are we prepared to grasp firmly onto health principles and practices that ensure not only our own well-being but also that of our children?

Until we adults are prepared to adopt better eating and lifestyle habits, including the elimination of animal fat in our diets and the diets of our children, we continue to will to our children, our grandchildren, and perhaps to future generations beyond them, the problems of obesity.

----Carol Laliberte, mother of Andrew, 4, is a college instructor, newspaper columnist, freelance writer and consultant. She lives in Western Massachusetts with her son, her husband, Phil, and their two fish, Seaweed and Week Week. She has been a vegetarian for more years than she can remember.