Many times I am asked what are a few straightforward and simple things I can do as a parent to help prevent obesity in my own child.  And while there are some more thorough discussions I have written in other articles on this website and on obesityprevention.org, I will describe here a few of the most important steps you can take today to prevent childhood obesity at home.

1. Set a great example.  Parents are powerful influences on children, but we lead more by example than by words so you must walk the walk quite literally speaking.  Be active and keep your own weight at a healthy level.  Avoid eating high calorie, high carb food, snacks and treats so you set the example for your child.
2. Read every label and encourage your children to read every label.  While the labels can be confusing and full of lots of useless information, they do contain some important bits of information so that you should encourage your child to always be aware of.   And here they are:  One, know the number of calories in every serving that you eat.  And two, know the number of grams of carbohydrates or sugars in everything you eat.  That’s enough, that’s all you really need to focus on and the rest will take care of itself if you stay mindful of these two figures.
3. Protein first.  This means every time you prepare a meal or snack you should be thinking             about protein first and foremost.  Protein provides greater satisfaction and does not result in immediate sense of rebound hunger like sugar does.  As a parent you are well aware of the sugar rush followed by the sugar crash, but you may not be as aware of the surges in hormones produced by sugar intake and how those result in rapid resurgence of hunger within about an hour.   Protein satisfies.  It is a good, healthy source of calories and don’t worry, your child will get plenty of carbs even without trying.  Let the protein (cheese sticks, protein bars, beans, nuts, meats and fish) satisfy them and they won’t be hungry for junk food so fast.
4. Clear out the pantry.  That’s right, you got it, this is tough love, but you need to get rid of all the high carbohydrate, high calorie snacks and treats, M&Ms, Ding Dongs, candies, chips and all those goodies that kids (and everyone else) love to eat.  It’s not doing anyone any good.  Stock your house instead with fresh fruits and vegetables and your kids will be just fine.  In fact they will be far healthier and less overweight as a result.  Sometimes parents tell me “my kid won’t eat anything but junk food.”  Trust me, if the house is full of delicious fruits and veggies and there is no junk food in the house then he or she will eat what is available and learn to love it.
5. Stay active and have fun at it.  Every kid should have 30-60 minutes of regular exercise every single day.  So make it a priority and find ways to make sure your kid is getting that activity.  Yes schools have cut physical education and we as parents no longer let our kids run loose in the neighborhoods like our parents did, but with a little effort you can certainly come up with an hour of physical activity for your kid.  Better yet do it with them.  Ride bicycles, take a hike, take the dogs out, sign up for sports, lessons, competitions, meets and tournaments.  Make sports and physical activity fun.  Find something your kid enjoys and support them.   Time will be a great investment in your child’s health.

The subject of children and adolescents potentially undergoing weight loss surgery has evolved greatly in a short number of years. When it was initially proposed the only operations were invasive procedures such as the open Roux-en-Y gastric bypass. With the advancements of minimally invasive surgery and laparoscopic instrumentation, there are now several minimally invasive choices, most notably the laparoscopic adjustable gastric band (LAGB, Lap-Band or REALIZE Band). The LAGB procedure does not involve any cutting, rerouting, reconnecting or other irreversible changes to the gastrointestinal system of a young person and so has emerged as a potential procedure, perhaps more worthy of consideration on a wider scale in young people.

The rationale for weight loss surgery being performed among young people is that serious comorbid conditions are developing in young people and extremely important formative events are occurring in social, intellectual, academic and career realms for the young person, all of which are profoundly negatively impacted by obesity. Weight loss surgery performed at a young age offers the potential benefit of impacting not only the young person’s health and quality of life, but also substantially enhancing long term prospects for improved career, earnings, relationship formation and social development. For this reason many advocates of childhood health and adolescent well being have endorsed the concept of offering weight loss surgery to obese adolescents and young people.

When should a young person be considered for weight loss surgery?

1. When the body mass index is over 35 it is reasonable to begin consideration.

2. When the body mass index is over 40 weight loss surgery should be included in any discussion with the patient and family of the weight loss options.

3. Attempts at non-surgical weight loss: young people by virtue of their higher resting metabolic rate than older persons, often have a greater ability to lose weight through non-surgical means. Additionally, young people may have a greater power to make behavior and lifestyle change than older people. So, determined efforts should be made to engage in non-surgical weight loss programs with a structured medically supervised approach involving dietary change, counseling, exercise, psychotherapy, use of protein based meal replacements and support groups. If these efforts fail then weight loss surgery should be considered.

4. Health status: For adolescents who have already shown health problems stemming from obesity such as type 2 diabetes, high blood pressure and obstructive sleep apnea, weight loss surgery should be a consideration.

5. Age: At what age should weight loss surgery be considered? This remains a debated topic. Our own center chose a lower range cutoff of age 15 below which we offer non-surgical, medically supervised weight loss. At 15 and above we will offer laparoscopic adjustable gastric banding weight loss surgery. At age 18 and above patients and families generally have the option of LAGB or laparoscopic Roux-en-Y gastric bypass surgery. Other centers around the country have chosen a lower age cutoff of, for example age 12 and above for consideration of weight loss surgery.

Tips for success with adolescents and weight loss surgery:

1. This must be a whole family effort. Everyone must be educated and motivated to help the young person succeed.

2. Support groups for the young person and the parents and siblings. This is not a “go-it-alone” journey. Quite the opposite is true. Support, encouragement and coaching from parents, siblings and peers enhances successful weight loss.

3. 0-calorie beverages. This principle must be enforced within the household to avoid “drinking all your calories” and maintaining resuming obesity.

4. Protein first. This principle means that everything eaten, drunk, prepared, bought, opened, sniffed or dreamed about must be protein first. This guarantees a greater sense of satiety and an emphasis on lower intake of simple carbohydrates, which are appetite stimulating.

5. Exercise for life. The habit must be engrained not only for the young person, but for the whole family that daily exercise is part of life even if it is simple walking. Exercise is a powerful predictor of long term weight loss success

Joanie has a great health show on the radio in San Francisco called the Joanie Greggains Show and I had the great privilege of appearing as a guest on her show this morning on March 27, 2010. We talked about Life Changing Weight Loss, the book, Joanie has some great questions about the inner motivation and the need to except internal change as a foundation for losing weight and keeping it off. We also talked quite a bit about obesity prevention among children and what it takes to fight that battle.

I think one thing many people in the public don’t comprehend is that times have changed and the environment surrounding our children is quite different now than it was thirty years ago. It definitely requires a much more active battle plan to prevent our children from becoming overweight and obese. It’s not just going to happen automatically. The environment is too rich in calories and carbohydrates and the environment also deters exercise and activity to such a great extent that most children are heading toward a path to overweight and obesity as they progress to adulthood. So as parents we must take a tougher line. We must cut against the grain of the school environments, the neighborhood environments, what is going on television and at our friend’s houses. We have to eliminate sugar beverages from the household, toss out all the snacks, candies, cookies and ice cream in the pantry and freezer and make those kinds of treats special occasion treats a couple of times a month, but not an everyday or every meal occurrence. We have to encourage ways for our children to get regular exercise and this can take some creativity given the demands and time pressures that most young students face and also the safety concerns that most parents have about letting children run loose in the neighborhoods. The battle can be won it just requires determination and a real effort.

A jarring study published in the New England Journal of Medicine followed 5,000 American Indian children from childhood through middle age and found that those subjects in the study who had been obese as children were more than twice as likely to die before the age of 55.

Although this study was conducted among Pima Indians who have historically had high rates of obesity, in truth, the obesity rates of these test subjects were on par with the current rates of childhood obesity today. For this reason, the study’s findings probably do indeed translate to the wider population. There are some specific factors among the Pima Indians that might make the study less generalizable, but, in my view, these are pretty minor factors, as the study focused on the increased risk that high body mass index brought to these people.

Research has been somewhat mixed on the topic of breast feeding as a protection against the development of childhood obesity. A University of Copenhagen study examined over 5,000 men and women who were born between 1959 and 1961. At one year the babies who were breastfed for longer periods of time have lower body mass indices. At additional endpoints though, later into childhood adolescence and adulthood, there was no further correlation between the duration of breast feeding and the body mass index. But, the introduction of solid foods at an earlier age was associated with a small increased risk of being overweight at age 42.

It is a bit difficult to know how much credence to give this single study, however interesting. There are undoubtedly benefits of breastfeeding that include nutritional and immunologic benefits as well as psychological benefits to develop in babies. Whether delaying the introduction of solid foods past four or six months does protect against obesity it is a bit difficult to determine, though there may be some small affect at work here. Generally speaking, breast feeding in the early months is healthy for the developing baby and beyond the first three or four months it is difficult to discern the strong effects with the transition to formula and food.

The Michelle Obama lead initiative to fight obesity in America is “Let’s Move”.

Let’s Move, describes that it will:
1.Give parents the support they need
2.Provide healthier food in schools
3.Help our kids be more physically active
4.Make healthy, affordable food available in every part of our country.

Let’s take a look at each of these sections. I am going to jump to healthier food in schools because this is such an important and also such a difficult one to achieve.

The Let’s Move website that discusses healthier schools begins with some very compelling background information such as many children consume at least half of their daily calories at school. The site then serves as a call to action for schools and communities to provide healthier school lunches and breakfast. The part of this is what is called the Healthier US School Challenge (HUSSC), which is established to “recognize schools that are creating healthier school environments through promotion of good nutrition and physical activity.” To be certified as an HUSSC school the school must meet certain criteria. The most important of which appear to be that lunches are offered demonstrate healthy menu planning and principles of the dietary guidelines for Americans and that meet USDA nutrition standards.
The overall initiative is described is one that partners with the US Department of Agriculture as well as major school food suppliers who have agreed to some changes in the meals provided and to meet standards from the Institute of Medicine within five years. There is also a commitment mentioned to double the amount of produce that is served within ten years. A proposal to add a billion dollars per year to help improve school lunches and update the Child Nutrition Act is also mentioned. It takes some digging, but ultimately this leads to a link of the Institute of Medicine recommendations about the nutrition facts recommended for school lunches and breakfast. Following the links and going down into the specifics of the nutrient contents that are recommended, one finds a very disappointing emphasis on dietary fat and very little actual mention of the main culprit of the childhood obesity epidemic, the increased consumption of simple carbohydrates. The recommendations for calorie targets are reasonable and beneath the calorie targets for specific nutrient guidelines, once again, indicate what percentage of the calorie consumption should come in the form of fats. A range of vitamins also are discussed.
While these guidelines in general will be helpful at providing some specific targets that would avoid the very overly calorie dense meals available at school lunches and breakfast, they offer an awfully bureaucratic and old fashioned kind of approach. Let’s all be clear, a massive health problem is occurring because kids are consuming massive amounts of carbohydrates. So to solve that it seems to me that schools need to, yes, create healthy breakfasts and lunches with reasonable calorie limitations, but should point out in glaring, big, bold letters that the carbohydrate content needs to be reduced. Secondly, an analysis of how children are then consuming the “extra” carbohydrate calories will lead to some additional solutions, such as replacing the soft drink vending machines and eliminating the availability of high carbohydrate snacks and treats and replacing them with healthier choices.
Look, I realize this is the Federal Government and it is the same government that has been subsidizing the production of high fructose corn syrup due to incomprehensible political machinations. But, our nation’s kids are getting fat and developing type 2 diabetes and the primary cause appears to be an increased consumption of simple carbohydrates. Let’s just shine a giant spotlight on the main problem and not get too distracted with all this Byzantine bureaucracy and the emphasis on an old fashioned food pyramid and a nonsensical obsession with dietary fat.
I applaud Michelle Obama for highlighting this issue and for adding the weight of her office to it. I know that much good can come of her and the President’s investment in this problem and then finding a solution for it. Focusing on healthier meals in schools is a critical step and their leadership is greatly appreciated. I am disappointed that the website on this highly important topic gives a very complex and diluted message that ultimately is backed up by a big, outdated bureaucratic notion and fails to unambiguously wag a finger at the massive carbohydrate consumption problem. We will look at more of these initiatives in future blog posts.

A disturbing study of British children found that among 12,000 3-year-olds, the risk of childhood obesity was 34% higher if grandparents cared for the children full-time.
Parents as caregivers and other substitutes like daycare centers and babysitters did not produce an increased risk of obesity, but grandparents as caregivers did.
While the study did not investigate the precise reasons why grandparents appeared to lead to greater obesity among these children, it is speculated that a more indulgent attitude toward sweets and treats and food choices may be the answer. What we might fondly recall as the sweet doting grandmother or grandfather who indulged us in home baked cookies and treats might have a darker implication in today’s environment of escalated childhood obesity. Grandparents may also be less physically active and may promote less physical activity among small children.

The White House has officially endorsed the “Let’s Move” campaign that is taking an ambitious approach to partner with food companies, media, athletes, school lunch providers and federal agencies in an effort to prevent childhood obesity. This is exactly the sort of effort this has been missing for the last thirty years, and most egregiously in the last ten years.

While I am not going to like every single aspect of the Institutes of Medicine’s recommendations, it is undeniable that this is a profoundly positive and massive effort to address a massive nationwide health problem. Nothing short of this type of initiative will succeed. In fact, this is probably only one of many critical steps that will be necessary to actually make a dent in the epidemic and decrease the rate at which our nation’s children become obese, develop diabetes and die at earlier ages, living less full lives.

I had the great pleasure of talking on the air with Bill Dean on his program The Morning Brew that airs in Minnesota. Bill is a fantastic host and we got to discuss the importance of weight loss and maintaining a healthy weight as well as my recently released book, Life Changing Weight Loss. Bill also noted he himself was diagnosed with vitamin D deficiency, a surprisingly common finding for a great many of us. Usually the symptoms of vitamin D deficiency are fatigue and loss of energy so they can be very subtle. Most people don’t even realize they have it.
We also touched on a number of topics including childhood obesity.
Bill is a great host and I hope I have an opportunity to appear as a guest on his show again.

A few weeks back Michelle Obama launched her national campaign against Childhood Obesity. I am very pleased to see that the first lady has chosen this incredibly important issue to help the future of America. I will be posting my thoughts from time to time regarding the progress and effectiveness of the “Let’s Move” Campaign headed up by Mrs. Obama. I have already sent her a letter thanking her for her efforts on this important cause. Let’s hope that together we can make progress to win the fight against childhood obesity.

Here is a copy of the letter:

February 17, 2010

The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500

Dear Mrs. Obama,
I am writing to thank you for your “Let’s Move” initiative and your efforts to raise awareness of childhood obesity and combat this serious health problem.
As a physician battling on the front lines of the obesity epidemic, I am grateful for your leadership and courage on this issue. I hope that our own Reno-based Obesity Prevention Foundation may be kept apprised of your further efforts and endeavors in this regard so that our community, schools and kids may be of benefit.
The complex problem of obesity requires a solution at many levels, at the personal and family level, at the school and community level, and at the state and national policy level. Your own work greatly helps our own local community effort with the Obesity Prevention Foundation as we work to educate parents and children, raise awareness of the disease and provide tools to combat and prevent it.
Best wishes to you and your family.
Sincerely,

Kent C. Sasse, M.D. , MPH, FACS
Founder of the Obesity Prevention Foundation
Medical Director, iMetabolic.com
www.obesitypreventionfoundation.org