No one likes being the odd person out. But if you are overweight and a kid, chances are you will not only be the last one picked for the team, you will also find it harder to make friends. Research shows that in the sometimes cruel world of children, overweight kids are more likely to be shut out socially than even kids with other physical challenges.
Add that to the fact that an overweight child runs a higher chance of being an overweight adult—and subsequently faces higher risk for heart disease, diabetes, cancer, arthritis and other diseases—and it is painfully clear that obesity during childhood needs to be prevented.
Unfortunately, like adults, more and more children in America are having trouble maintaining an appropriate weight. At least one-in-five kids today is overweight, a 50 percent jump in the last two decades. As our children grow heavier, health professionals and parents alike want to know why and how to prevent it.
In late May 1997, the International Food Information Council (IFIC) brought together more than 90 nutritionists, health professionals, government officials and journalists in Washington, D.C., to explore the problem and potential solutions. The roundtable, "Food, Fitness & Fun: Communicating to Kids," examined both the reasons why America's kids are getting fatter and strategies for preventing childhood obesity.
Sorting Out the Questions
When it comes to obesity, there is more involved than just what a person eats and his or her activity level. According to Dennis Bier, M.D., director of the Children's Nutrition Research Center at Baylor College of Medicine in Houston, a significant amount of our weight is determined by genetics. In this country, that means many people are destined to struggle with weight throughout life.
Still, genetics alone do not explain the dramatic increase in obesity seen in children in recent years. "It takes eons for genes to change," said Bier. "Even though genes will tell us a lot about someone's susceptibility to obesity, they're not the reason why there has been a [recent] change."
With genetics ruled out, attention turns to the classic energy balance equation. Is the amount of calories kids eat in balance with how much physical activity they get?
Eating too much has traditionally received much of the blame for America's weight problems. But information from recent dietary surveys suggests how much children are eating may not play a major part in obesity increases among them. Phase I of the third National Health and Nutrition Examination Survey (NHANES III) conducted from 1988 to 1991 showed calorie intakes among most age groups did not increase compared to intakes in the previous decade.
A Trend in the Wrong Direction
Looking at the energy expenditure side of the equation, indicators do suggest a trend in the wrong direction. Specific data on how much physical activity kids get are sparse. While dated, the best information comes from the 1985 National Children's Youth Fitness Study. It showed kids averaged about 100 minutes of physical activity daily. Other studies suggest youth engage in physical activity on an average of one hour a day.
That may sound good, but an average does not reflect the differences among children. And differences in physical activity can translate to differences in body weight. "There's an awful lot of variability in activity in both genders at all ages," said Russell Pate, Ph.D., professor and chairman of the Department of Exercise Science at the University of South Carolina. "Some kids move all the time; you can't stop them. Others are real couch potatoes and just don't move very much at all."
Perhaps more ominous is information that suggests as kids get older, physical activity decreases. The trend does not bode well for adulthood. In 1993, about 80 percent of ninth-grade boys and girls were enrolled in physical education, and about one-half said they participated in it on a daily basis. "But by grade twelve, enrollment and participation in a daily physical education class goes way down, particularly among girls," Pate pointed out. "A lot of us are very concerned about physical activity in adolescent girls."
Getting Kids to Move
Research has identified a variety of factors that predict whether children will be physically active. Many of these factors form barriers against physical activity, and they must be recognized if efforts to increase physical activity are to be successful. Among those are time spent outdoors, which is affected by relatively innocuous issues such as the weather but also by more serious concerns such as children's safety. Access to adequate space and equipment ranks as a real issue for many kids today, too.
In addition, how a child thinks and feels about physical activity has a significant impact on his or her participation. Enjoying physical activity is perhaps the most powerful psychological influence, Pate explained to the audience, meaning fun and pleasure are key to successful physical activity programs.
A child's physical activity self-efficacy, or confidence in his or her ability at sports, games and active play, is also crucial to developing a positive attitude about physical activity. Positive experiences go a long way toward building a child's confidence.
Then there is the question of what everyone else is doing. According to Pate, social norms and influences are extremely powerful shapers of physical activity behavior. "If you want a youngster to be active, put him in the middle of a social group that is being physically active, and I think you are likely to get activity," he said.
Indeed, peer influences outrank parental influences as children grow older. But there is no ignoring the critical role of adult modeling and support in keeping kids active. "Kids who operate in settings in which there are rules that prompt activity or limit inactivity do tend to be more active," commented Pate. Turning it Around
The Centers for Disease Control and Prevention (CDC) recently issued guidelines for school and community programs to promote lifelong physical activity among young people (see sidebar). The guidelines include recommendations for 10 aspects of school and community programs. According to Pate, perhaps the most important recommendation focuses on public policy.
According to Pate, "The challenge is to get the public and decision makers to take this seriously and to reinvest existing resources—perhaps invest new resources—in attacking the problem."
Among the recommendations of the CDC guidelines is a requirement for daily physical education in schools and comprehensive school health education. There is also a need to modify the focus of physical education programs.
"In physical education, the tradition has been to deal with physical skills, such as learning to play a sport," said Pate. "But physical education also needs to emphasize the behavioral skills associated with developing an active lifestyle, such as how to become less sedentary."
Programs that allow kids to be active at school are also important. After and outside of school, extracurricular activities need to be offered that appeal to all kids, not just athletically able boys. "There's nothing wrong with softball and football programs, but they don't serve the needs of all kids," said Pate. "We need to broaden that menu." Communicating to Children
One of the primary purposes of the IFIC roundtable was to give professionals working to promote optimal growth and development for children a chance to develop nutrition and physical activity messages that would actually be tested in a focus group conducted at the meeting. Several speakers provided background for the message development sessions.
To successfully guide children, Judy Dodd, M.S., R.D., a nutrition education specialist and educator with the University of Pittsburgh, stressed that adults must take the lead in setting up child-friendly environments that will help children develop healthful eating and physical activity habits.
"Children are clearly not autonomous, even though they'd like to think they are," Dodd said. "Adults are role models and mentors and providers. Regardless of their level of independence, children are dependent on adults for what's in a home, what's in a school, what's in a community and what their choices are."
In particular, she warned against transferring the fear of fat that has been part of adult thinking for several decades. "The emphasis on weight without the balance of a total health message is affecting even young children," Dodd said. "Ten percent of all African-American and 14 percent of all Caucasian children are underweight but are reporting dieting. Children as young as six have been treated for obsessions with dieting and weight."
To effectively communicate to children about nutrition and physical activity, it is necessary to have some insight into what they know and believe about the subjects. Barbara Rosenthal, M.S., president of Rosenthal Qualitative Research, shared the results of focus groups that tested messages targeted to children and their parents about nutrition, health and physical activity. The focus groups were commissioned by IFIC late in 1996.
"A lot of the themes we heard from the other speakers at the roundtable were reflected in the focus groups," said Rosenthal. "One theme has to do with modeling, or the influence of parents. Parents are aware of their influence on children, but they talk about their own habits differently from their children's habits. One wonders if some messages need to be sent about modeling."
Rosenthal also pointed out that while kids today are politically correct about nutrition, they may not have a true grasp of the subject. "They know what they're supposed to say," she said. "But, it's helpful to spend some time with them to really understand what they are thinking and what their attitudes are."
The roundtable ended with a focus group with 12- and 13-year-old girls to test the eating and activity messages developed by participants. The results?
"The focus groups showed we need to better understand what makes for a child-friendly environment," said Susan Borra, R.D., senior vice president and director of nutrition at IFIC. "The diet and activity messages we adults thought would be fun and inspiring were interpreted very differently by the girls in the focus group. It shows we need to let the kids themselves have some input if we are going to be successful in shaping their health habits."
Physical Activity: Do Kids Get It?
Who are America's couch potatoes? Kids are, according to them and their parents in a recent national survey. But the good news is that the parents say they are willing to help their kids "get moving" towards more physical activity.
The survey was commissioned by the International Life Sciences Institute (ILSI) through their Physical Activity and Nutrition Program (PAN) in partnership with the National Foundation of the Centers for Disease Control and Prevention. In 1996, ILSI launched PAN to address the alarming increase in childhood obesity in recent years.
The telephone survey of over 1,500 families investigated both parents' and their childrens' attitudes toward and habits regarding physical activity. The research revealed that fewer than one-out-of-four youngsters in the fourth through twelfth grades gets vigorous physical activity every day of the week.
"Daily physical activity for children needs to become a priority for parents equal to that of buckling seat belts," says James O. Hill, Ph.D., chairman of the PAN Advisory Committee and professor of pediatrics and medicine at the University of Colorado Health Sciences Center. Survey Highlights:
- Fewer than 25 percent of kids get vigorous daily activity.
- Ninety-three percent of kids say they enjoy physical education in school, but only one-in-three kids attends PE every day.
- Parents who are physically active are more likely to have physically active
children.
- Parents and children say they are willing to volunteer to make more and better programs a reality.
