News You Can Use on Children's Health Topics

Dieting and Weight:

Obesity, TV and Soft Drinks

A new study suggests that kids who spend more time watching TV and who drink more soft drinks – even diet drinks – are more likely to be obese.

The study was based on more than 400 sixth and seventh graders ages 11-13 in three schools in Santa Barbara County, Calif., during the 2000-2001 school year. Children with diabetes or in a wheel chair were excluded from the study. Since most children were Latino, white or Asian, other groups were excluded from the study.

More than 800 children were asked to participate in the study, but since written consent was requested from parents, only half (51%) agreed. In addition to being evaluated in terms of their height and weight, the children underwent body fat measurements and blood tests (perhaps that’s why consent was low). The children also filled out a questionnaire that was designed to be completed in 3-5 minutes. It included 18 lifestyle questions about TV viewing, sports, whether they walked or biked to school, soft drinks consumed per day, diabetes, and how they would rate their weight (overweight, just right or underweight).

Many of the children were obese: 18 percent were between the 85-95th percentiles body mass index (BMI) and 17% were above the 95th percentile.

Obese children differed from their classmates on only two lifestyle questions: TV and soft drinks. Children who averaged two hours of TV or more on week nights had a BMI that was 48 percent higher than their classmates and had 5 percent more body fat. They also were 80 percent more likely to have a BMI above the 85th percentile. The pattern between weight and video or computer games was similar but not statistically significant.

Kids who drank 3 or more soft drinks per day had a BMI score that was 51% higher, they had 4% more body fat, and they were almost twice as likely to have a BMI above the 85th percentile. Surprisingly, obese children tended to drink more diet soft drinks rather than drink more regular soft drinks. Since their drinking habits for regular soft drinks and diet soft drinks were so similar, diet and regular soft drinks were combined in the rest of the analyses.

Latinos spent more time watching TV and drank more soft drinks compared with non-Hispanic whites or Asians. When ethnicity was controlled, TV viewing was no longer a significant predictor of obesity, but soft drink consumption was.

Although interesting, this study is hard to interpret, because half the students in the schools didn’t participate.

Why did obese children differ from their classmates on only one activity and only one kind of food? The authors point out that perhaps TV viewing is connected to eating, while computers and videogames require two hands and neither include food advertisements (yet). They also speculate that kids who drink more soft drinks may also eat more junk food. Children who drink diet soft drinks might be doing so because they are already obese, rather than being obese because they drink diet soft drinks.

The study raises questions about TV viewing and soft drinks as symptoms of other problems, as well as habits that adults might want to try to curb rather than ignore or encourage.

Reference:

Television Watching and Soft Drink Consumption
Joyce Giammattei, Dr.P.H., Glen Blix, Dr.PH.. Helen Hopp Marshak, Ph.D. and colleagues
Archives of Pediatrics and Adolescent Medicine, Vol. 157, September 2003, pgs. 882-886.

Sticks and Stones: Does Teasing Hurt?

Despite the claim that “names will never hurt me,” everyone knows that name-calling does hurt. A study published in a pediatric journal in August 2003 shows the pervasiveness of teasing about weight among adolescents, and how it influences youths’ self-esteem, depression and thinking about suicide – regardless of how much the youth actually weighs.

The study was conducted on more than 4,700 ethnically diverse adolescents in grades 7 to 12 in 31 public middle schools and high schools in Minneapolis/St Paul. Approximately half were female, half were white, half were middle class or upper middle class, and two-thirds were high school students.

Thirty percent of the girls and 25% of the boys reported being teased about their weight by their peers, and almost as many (29% of girls and 15% of boys) reported being teased about their weight by family members.

The kids were assessed on five emotional health measures: body satisfaction, self-esteem, symptoms of depression, suicidal thoughts and suicide attempts. On all five measures, kids who reported being teased about their weight by peers or relatives had more problems than did kids who were not teased at all. If they were teased by both peers and relatives, they reported even more problems than those teased by peers or relatives.

These differences are substantial. For example, more than half the girls teased by peers and family members reported that they had thought about suicide, compared with one in four of those not teased. Also, almost one in four had attempted suicide, compared with nine percent of those not teased. Boys teased by peers and family were three times as likely to attempt suicide (12%) than those not teased (4%).

These results are shocking, but the question arises: Are these adolescents having problems because they are being teased or because they are overweight? Or perhaps adolescents who are overweight might tend to be from certain ethnic groups, and might have problems because of other types of discrimination. The researchers statistically controlled for these possible influences, and found that kids who were teased about their weight still had more negative views of themselves and were more suicidal than were kids who were not teased.

In fact, when the amount of teasing was controlled for, kids who were overweight did not have lower self-esteem, more suicidal thoughts, or more suicidal attempts than did other kids. Although boys who were overweight were more depressed than boys who were not, this was not true for girls. And the negative influence of teasing was apparent in every ethnic group.

The one major shortcoming of the study is that the teasing is all reported by the youths. It is certainly possible that kids who are depressed or who have lower self-esteem or poor body image are more sensitive to teasing and therefore more likely to report it. Nevertheless, it seems likely that teasing itself has a negative impact.

Adults often assume that teasing is an inevitable part of childhood. Although such remarks may not seem as demeaning as ethnic or racial slurs, this study suggests that these remarks deserve the same kind of attention from adults. The rates of suicidal thoughts and attempts were alarmingly high for all the youths, and especially frightening for girls who report being teased about their weight.

Reference:

Associations of Weight-Based Teasing and Emotional Well-being Among Adolescents
Marla Eisenberg, ScD, MPH, Dianne Neumark-Sztainer, PhD, MPH, Mary Story, PhD
Archives of Pediatrics & Adolescent Medicine, Vol. 157, August 2003, pgs. 733-738.

Weight Report Cards?

Concern about obesity has started to influence how schools see their roles. In Cambridge, Mass., the public school system tried a novel approach: “health report cards” that informed parents of their child’s height, weight and “weight status” (overweight, at risk for overweight, healthy weight, and underweight) and fitness test results. The report card explained the test scores and referred parents of children who were not in the healthy weight category to follow up with a family doctor or school nurse.

Although best known for Harvard University and MIT, Cambridge is an ethnically, racially, and linguistically diverse city, with families representing at least 65 countries. Approximately half the children in public schools are eligible for subsidized school lunches. Children in this study were from four elementary schools and were studied in 2001, before obesity became such a hot topic in the United States.

The study included three groups: one group received the weight report card and health tips, one received health tips, and the third was a control group that received no materials. The “health tips” information made recommendations such as the importance of eating five servings of fruits and vegetables each day and limiting children to less than two hours each day of TV or videos.

The impact of the weight report cards and the health tips was measured by telephone interviews that were conducted with 399 families. Many families did not recall receiving the materials, but those who received the personal report cards were more likely to remember them than those who received only the general health tips.

As was found in previous studies, many parents (43%) of overweight children reported that they thought their child was of a healthy weight. Compared with the other parents, those who received the weight report card were more likely to be correct, but the researchers described the impact as “modest” and speculated that the information in the report card might have been difficult to understand.

Parents who received the health report card or the general health tips were more likely to correctly identify their children’s weight status, compared with the control group. Neither of those materials had a clear impact on parental concerns about their children’s weight. However, parents who received the report cards were subsequently more likely to report initiating or planning dieting, physical activities, or weight-related services than were those who received the general health tips or no materials.

Of the only 52 parents who reported discussing the materials with their children, those who discussed the report card were more likely to report that their children were uncomfortable with the discussion than those who reported discussing the health tips. Overweight children were somewhat more likely to report that they were uncomfortable (60%) with the conversation, but many healthy-weight children were also uncomfortable (41%).

Although the response rate for the phone interviews was only 50%, only 2% refused to participate. The others had disconnected phones, could not be reached by phone or did not return messages. This suggests that those participating in the interview may have been even more likely to have received and read the materials than those who didn’t participate.

The results were disappointing but not surprising, given the difficulty of ensuring that materials sent home by school children are given to parents or read by them. The good news is that the parents who remembered receiving the report card thought it was a good idea and hoped to get one every year. The bad news is that many of those with overweight children did not recall that their child was listed as overweight, were not concerned with their child’s weight, and had done nothing to remedy the situation.

References:

Promoting Healthy Weight Among Elementary School Children via a Health Report Card Approach
Virginia Chomitz, PhD, Jessica Collins, MS, Juhee Kim, MS and colleagues.
Archives of Pediatrics & Adolescent Medicine, Vol. 157, August 2003, pgs. 765-772.

Recreation Programs Work

It makes logical sense, but it is still reassuring that a study shows that an organized, non-competitive, leisure-time program can in fact increase kids’ physical activity.

This very small study evaluated only four 12-year-old boys and girls who participated in a summer program at least 75 percent of the time, and eight 10- to 11-year-olds participating in the fall after-school program at least 75 percent of the time. Both programs were held outdoors on public school grounds in Columbus, Ohio.

The activities included gardening and an “adventure education” program. The gardening program was held for 30 to 45 minutes each day, and children assisted in planning, cultivating, planting, maintaining and harvesting in the summer, with some activities continuing into the fall. The school cultivated the ground and local nurseries donated the herbs and other plants. The produce was sold at a farmer’s market, and the proceeds went to the school. The children were paid $25 each for participating in the evaluation.

The Adventure Education program was an hour each day, and consisted of adventure games to teach kids to solve problems (including succeeding in an athletic contest) by playing with other kids. The games required constant movement. For example, in a version of “sharks and minnows,” the shark stands near a water sprinkler that the other kids must run through to stay wet while they try to avoid being tagged. Those who are tagged all become sharks, so all kids stay in the game until there is only one minnow left.

During the summer, the weather was hot and there were frequent water breaks, during which the children were not physically active.

Physical movement was measured by a uniaxial accelerometer strapped to the wrist, which measures calories used, and a breath test used to measure carbon monoxide production. For the summer program, physical movement was significantly increased and carbon monoxide production was increased by 60%, compared with watching a video. In the fall program, there was a 95% increase in physical movement compared with when the children were home.

Although it is hardly surprising that recreation programs result in increased physical activity, the authors point out that the results are encouraging because the programs were not designed for children with athletic interest or skills. All they need to participate is “a reasonable desire to socialize with other children and adults.” For that reason, these kinds of recreation programs could attract the kinds of children who most need them – those who are not good at competitive sports and not especially athletic, and who are therefore less likely than other kids to be involved in physical activities.

Reference:

Physical Activity in Middle School-Aged Children Participating in a School-Based Recreation Program
C. Lawrence Kien, MD, Ph.D., and Andrew Chiodo, MA
Archives of Pediatrics & Adolescent Medicine, Vol. 157, August 2003, pages 811-815

Reading, Writing and Soft Drinks

The sale of soft drinks from vending machines in schools has been a controversial topic for years, as more schools have come to rely on the income from these machines for activities such as field trips and sports. Although less controversial, soft drinks are also available at or near recreation centers, after-school and summer youth programs, schools where athletic events are held, treatment centers and other places where youth spend their time.

In January 2004, the American Academy of Pediatrics published a policy statement on soft drinks in schools, which includes a summary of research that is relevant to all youth workers.

The pediatricians point out that there are three major health reasons for concern about soft drinks: impact on obesity; calcium deficiency because youth who drink soft drinks will drink less milk, and tooth decay and possible erosion of tooth enamel.

The research summary points out that soft drink consumption has tripled over the last 20 years, and that between 56-85% of school-age children drink at least one soft drink every day. Drinking an average of one more 12-ounce soft drink per day translates to a 60% increase in the risk of obesity. In addition, soft drinks increase the risk of tooth decay.

Children and youth drink less milk as they drink more soft drinks, a change that typically occurs between third and eighth grades. In addition to calcium, milk contains other important nutrients that are important for kids’ health. The decrease in milk consumption can be harmful to kids whether they are substituting bottled water, diet drinks, juices or regular colas. Unless the soft drinks contain calcium (as some juices and smoothies do) this decrease threatens the development of bone mass, 40% of which occurs in adolescence. If bone mass isn’t fully-developed during adolescence, it can’t develop later.

The policy statement points out that some superintendents, school board members and principals claim that selling soft drinks in schools is good for schools and taxpayers, but the decisions tend to be made by business offices without input from health care professionals. The health care professionals say these decisions need input from others, not just those concerned with finances.

The policy statement is focused on pediatricians but is equally relevant to most youth workers. It’s recommendations:

1. Work to eliminate sweetened drinks in schools.

2. Advocate for the creation of school nutrition advisory council of parents, community and school officials, food service representatives, physicians, school nurses, dieticians, dentists and other health care professionals.

3. School districts should invite public discussion before making decisions about vending machine contracts.

4. If a school already has a soft drink contract, efforts should be made to reduce the use of soft drinks, such as by not selling them in competition with or as part of a school lunch program, turning them off during lunch hours, not providing financial bonuses to schools based on the amount of soft drinks sold, and installing vending machines that sell real fruit and vegetable juices, water, low fat milk, and drinks that are sugar-free or low in sugar.

The statement provides excellent research resources on the topic, including 34 references, most from medical and journal articles on topics ranging from the link between colas and bone fractures, the nutritional consequences of diet and regular soft drink consumption, and cola wars in schools.

Reference:

Soft Drinks in Schools
American Academy of Pediatrics Policy Statement
Pediatrics, Vol. 113, January 2004, pgs. 152-154

Obesity Hurts Quality of Life

Obesity is in the news as a public health crisis, and an important new study shows that the emotional harm may be as bad as the physical harm. According to the children and their parents, the quality of life of obese children is comparable to that of children who receive chemotherapy for cancer.

Needless to say, children receiving chemotherapy have a much lower health-related quality of life, on average, than do healthy children.

Dr. Jeffrey Schwimmer and his colleagues asked 106 children and youths (ages 5 to 18) and their parents to fill out a survey asking about the child's physical, emotional, social and school functioning. The youths had recently been referred to gastroenterology or nutrition clinics at Children's Hospital and Health Center in San Diego.

Children's health-related quality of life included their ability to move around and participate in sports, their levels of fear and sadness, the quality of their relationships with their peers, and how much they pay attention in school and do their school work. The study compared the scores of obese children with those for a sample of more than 8,000 healthy children and youth of the same age, and with 106 children who were receiving chemotherapy at two large children's hospitals in San Diego and Los Angeles.

Previous studies report that children with cancer who are receiving chemotherapy have the lowest health-related quality of life compared with both healthy children and other children with serious health problems, such as juvenile rheumatoid arthritis and congenital heart disease.

When they compared the obese children with the healthy children and children receiving chemotherapy, the authors found:

Obese youth missed an average of 4.2 days of school in the month before the survey, compared with less than a day for healthy children and youth.
Obese children were more than five times as likely to have a significantly lower quality of life than the average for children of that age. The quality of life for 40 to 65 percent of obese children was impaired by health-related factors. These differences were found for all aspects of children's lives, including their physical, emotional, social and school functioning.
The parents of obese children reported that their children's quality of life was lower than did the parents of healthy children. The parents of obese children even reported levels that were lower than those reported by the obese children themselves.
Obese children were about as likely to have an impaired health-related quality of life as the children receiving chemotherapy for cancer.

Differences in the age, sex, race/ethnicity and socioeconomic status of healthy and obese children did not account for these findings.

The implications for the emotional health of obese children are staggering. However, since the study included very obese children, these findings may not be true for kids who are less obese. Because the study was conducted on children and youth in Southern California, its findings may not hold true for obese children in other parts of the country. For example, in areas where childhood obesity is especially common, such as Texas and Alabama, kids who are obese may have more friends and feel better about themselves.

Reference:
Health-related Quality of Life of Severely Obese Children and Adolescents,
Jeffrey Schwimmer, Tasha Burwinkle, and James Varni,
Journal of the American Medical Association, Vol. 289, April 9, 2003, pgs. 1813-1819.
Available from Schwimmer at jschwimmer@ucsd.edu

Curing Obesity?

Childhood obesity has been in the news lately, with growing evidence that it has doubled or tripled in the US in the last generation, more than doubled in England during the last decade, and increased dramatically in other countries as well. Obesity causes high blood pressure, diabetes, and other health and social problems for children and increases the risk of premature illness and death from heart disease later in life.

A new article summarizes what research tells us about the causes and consequences, as well as a "common sense cure."

Causes

Children who are less physically active or view the most TV tend to be the most overweight. Children who watch more TV tend to exercise less and they also tend to eat more high-calorie foods. In contrast, eating family dinners is associated with decreased TV viewing, and eating healthier foods.

Environmental causes of obesity include advertising fattening foods, the widespread popularity of candy and high calorie fast foods; and large portions in restaurants and fast food industry. Lack of exercise is another major cause.

Prevention and Treatment

Most weight loss programs for children are based on family interventions. These programs are apparently only modestly successful, whether they include family therapy or train parents to use rewards for exercise or improved eating habits.

School-based programs such as Planet Health aim to decrease fat consumption, increase the eating of fruits and vegetables, promote physical activity, and limit TV time. The program were somewhat effective for girls but not for boys, but mainly by reducing TV viewing. The Pathways program for Native American children was a cooperative effort involving teachers, families, and the school meal programs. The result of that program was that the children ate less fat, but there was no difference in their obesity.

The authors were even less enthusiastic about diet pills as a weight loss strategy.

Based on their review of the research, the authors made the following "Common Sense" suggestions to prevent and treat obesity:

Home: Set aside time for healthy meals and physical activity and limit TV
School: mandatory physical education, stricter standards for school lunch programs, eliminate unhealthy foods from vending machines, and provide healthy foods in vending machines and concession stands
Urban Design: protect open spaces; build sidewalks, bike paths, parks, playgrounds, and pedestrian zones
Health care: improve coverage for obesity treatment
Marketing, media, and policy: tax on fast food and soft drinks, subsidize fruits and vegetables, require nutrition labels on fast food packaging, prohibit food ads or marketing that targets children, and regulate political contributions from the food industry

Since weight loss programs are not usually very successful, changing the environment to include fewer fattening foods and more healthy food and exercise could be key. These are the kinds of strategies that parents, relatives, childcare workers, and other adults who spend time with children can implement.

Reference:
Childhood obesity: Public-healthCrisis, Common Sense Cure
Cara Ebbeling, Dorota Pawlak, and David Ludwig
The Lancet, August 10, 2002, Vol 360, pgs. 473-82
Available from Dr. Ludwig at david.ludwig@tch.harvard.edu

Free Time

Young children like to run around when they play, but the older they get, the more sedentary they become. Team sports keep some adolescents active, but a new study confirms what most youth workers already know: physical activities decline during the teenage years. Fortunately, the study provides enough information to help youth workers think of ways to reverse that trend.

The study followed 782 7th, 8th and 9th graders who were 12 to 15 at the start of the study and 16 to 19 at the end. All attended suburban public schools in Pittsburgh. Eighty percent were white and most of the others were African American.

Physical activity decreased substantially over the four years of the study. On average, boys were more active than girls at each age, but the decline over the four years was 43 percent for boys and 26 percent for girls.

Much of the decline was due to the decrease in the actual number of physical activities that the youths participated in, which dropped by 56 percent, from an average of seven to three. Only 5 percent reported an increase in activities, whereas 85 percent reported a decrease. There was an 80 to 90 percent chance that an adolescent would discontinue any given physical activity over the four years of the study.

Even so, the more physically active the youths were at the start of the study, the more active they were likely to be at the end. Participating in fewer activities at the end of the study was related to lower socio-economic status for boys, and to being older or African American for girls.

In contrast, the amount of time spent on specific sports activities did not necessarily change. Boys and girls who reported the same activity at the start of the study as they did four years later tended to spend the same amount of time on that activity. The exception was that boys who continued to play basketball tended to report spending more time as they got older.

The top 10 activities reported were: aerobics, baseball, basketball, bicycling, bowling, football, roller-skating, running, skateboarding, soccer, softball, street hockey, tennis, volleyball and weight lifting. Boys were more likely to report participating in baseball, basketball, football, street hockey and weight lifting, while girls were more likely to report participating in aerobics and softball.

Overall, the likelihood of participating in each sport decreased over the four years, but there was increased participation in aerobics among girls and in roller-skating and softball among boys. Weight-lifting also became more popular for both boys and girls. The activity that was most likely to be stopped was bicycling.

Part of the decline in physical activity may be related to school requirements. Only 49 percent of the youth in grades nine through 12 were enrolled in physical education (PE) classes and only 27 percent attended PE classes every day. The lack of PE may decrease the incentive to continue in a sport and decrease the chances of being exposed to a new sport that is enjoyable.

The authors suggested that since most kids decrease the number of activities over time, it is important to encourage young adolescents to try lots of different physical activities, in the hopes that they will continue with at least some of them. That is an interesting theory that is consistent with the decreased number of activities over time, but it's not clear that the strategy would actually work.

The opposite strategy might work just as well, or better: young adolescents who are not very athletic should perhaps be helped to find just one or two sports where they can succeed. After all, kids' participation in sports is not random, but instead reflects their athletic abilities and interests. Young athletes tend to try a lot of sports because they enjoy sports, doing well at sports is reinforcing, and their friends want them to join their teams.

As they get older, different sports interfere with each other (soccer, for example, is now played year-round in many communities) and athletes are likely to be encouraged by parents or coaches to focus on fewer sports in order to excel.

Less athletic youths may try various sports but drop out because they are discouraged by their lack of skill. If these youth become involved in many sports when they are younger, they may just get more discouraged more quickly. If they were instead guided to focus on a few sports where they are most likely to excel, they might enjoy themselves more and be more likely to stay with those activities.

So the implications may be more complicated than the authors suggest. Parents and schools and other adults should certainly encourage children of all ages to be involved in physical activities, but to help youth stay physically active we need to find ways to make sports more enjoyable for adolescents of all ages, and to help less athletic adolescents find sports and other physical activities that they will want to stick with.

Reference:
Longitudinal Study of the Number and Choice of Leisure Time Physical Activities From Mid to Late Adolescence
Deborah Aaron, Ph.D., Kristi Storti, M.S., Robert Robertson, Ph.D., and others.
Archives of Pediatrics and Adolescent Medicine, Vol. 156, Nov. 2002, pp. 1075-1080
Available from debaaron@pitt.edu.

Weight and Body Image: A Problem for Boys and Girls of All Races

Everybody knows that adolescent girls have concerns about weight and dissatisfaction with their bodies, but a new study of third graders in California raises questions about whether these concerns have now spread to much younger boys and girls.

The study of 895 third graders attending 13 Northern California public schools found that half the white girls, more than two-thirds of the African American and Hispanic girls, 43 percent of the Asian Americans, and one-third of the Filipino girls expressed concern over their current weight, dissatisfaction with their bodies, or attempts to lose weight by dieting or fasting. Even more surprising, 61 percent of African American boys and between 35-45 percent of whites, Hispanic, Asian American, and Filipino boys expressed similar concerns.

When eating disorders were first studied in the late 1970's and early 1980's, they were primarily a problem of white, relatively affluent girls. In contrast, this study found that inappropriate eating attitudes and behaviors were common among boys and girls of all ethnic groups and in a wide range of social class, regardless of the weight of the children involved.

The authors suggest that adults need to help provide young children with more information and encouragement to develop healthy eating behaviors, weight control strategies, and to get more exercise. Youth workers have an important role to play, since food, snacks, and exercise are a major part of many youth activities.

Of course, not all children who are unhappy about their bodies are overweight or think they are overweight. Some children may worry that they are too skinny, or may dislike their bodies for other reasons. And, there are other studies indicating that obese children are often unaware of how overweight they are. Is it possible that both findings are correct and there are so many obese children, that even though many are unaware of their problems, many others are concerned about their bodies whether they are overweight or not? Or does the fault lie with questionable role models, such as Britney Spears and steroid-pumped male athletes, who have inspired even young children to be aware of their bodies and to consider them inadequate, much as their older sisters do?

Another new study, recently published in the Journal of the American Medical Association, indicates that an increase in overweight is real, and not just perceived. Dr. Richard Strauss found that the percentage of overweight children increased from 9 to 11 percent in western states from 1986 to 1998 and from 8 to 17 percent in the South. More than one in four (27 percent) of low income Hispanic and African American boys were overweight, and the statistics were not much better for upper income African American children.

This study is based on the National Longitudinal Survey of Youth, which includes more than 8,000 children representing children across the country between 4-12.

One odd note: overweight was defined as the top 5 percent of body mass index for age and sex. Since it is not possible to have more than 5 percent having the top 5 percent body mass index, this suggests that the standards need to be redefined.

The increases in overweight since 1986 were relatively minor for affluent white girls, compared to other students. For example, in 1986, the percentage of overweight children was almost identical for upper income white girls and lower income African American and Hispanic boys (approximate 6.5 percent for each). However, by 1998, the percentage of overweight upper income white girls had increased to 9 percent, compared to 27 percent for lower-income African American and Hispanic boys.

The irony of these two articles is that the second one may contribute to the obsession with weight that the first one reflects. How is it that at the same time that even young children are worried about their bodies, children and adults in the U.S. are more overweight than ever before? Part of it seems to be the availability of snack food, which research has shown encourages children and adults to eat even when they are not hungry. And, remember when a large Coke was 12 or 16 ounces (instead of 32!) and when movie popcorn came in just two small sizes?

Most parents, teachers, and youth workers can't control the portions at movies and restaurants, but they can sometimes limit access to vending machines and junk food; encourage youth to drink water by making sure it is available whenever possible, encourage and try to provide fresh fruit, salads, and other healthy foods at least some of the time; and try to limit portion sizes to a reasonable caloric intake. When parents and adults who work with kids are sensitive to these issues, they can help youth avoid obesity without adding to the obsession with body image.

References:
Overweight Concerns and Body Dissatisfaction Among Third-Grade Children
Thomas N. Robinson, JY Chang, KF Haydel, and JD Killen
Journal of Pediatrics, February 2001, Vol 138, No. 2, pgs 181-7

Epidemic Increase in Childhood Overweight, 1986-1998
Richard S. Strauss MD and Harold A. Pollack, Ph.D.
Journal of the American Medical Association, December 12, 2001, Vol 286, No. 22, pgs 2845-8
Free from Dr Strauss at strausrs@rwja.umdnj.edu

Invisible Obesity

Ever wonder why some parents let their children get so overweight that their health and quality of life are compromised? According to two new studies, many parents of extremely overweight children don't realize that their children are so heavy. As a result, they don't make any effort to improve their children's eating habits. Other family members, teachers, and adults need to find a way to to help those children and their parents.

The study reported in Pediatric News was conducted on children ages 1-5 and their parents. All the families were participants in New York's Women with Infants and Children (WIC) program. Many of the children were very overweight: one-third were in the top 15 percent of weight for their age and sex, and just under 20 percent were in the top 5 percent.

There were many overweight children in all ethnic groups in the study, but Hispanic children were most likely to be obese (39 percent) and white children were least likely (31 percent).

More shocking than the obesity was the fact that the parents were oblivious to it. Of the parents whose children were in the top 5 percent BMIs (the body mass index that is the new way to measure obesity), only three percent called their children "overweight"; 25 percent described their child as "slightly overweight." For parents of slightly less obese children (still within the top 15 percent of BMI), only 3 percent described their child as even "slightly overweight."

Hispanic parents were least likely to realize that their children were overweight, and most likely to think that their normal weight children were "underweight." Parents who didn't think their child was overweight were more likely to feed their child whole milk, less likely to limit overall food intake, and more likely to use dessert as a reward.

A different study, published in Pediatrics, indicated that this problem may be less extreme, but still worrisome, for parents of teenagers representing the entire country. In this study of more than 15,000 interviews with youth and their parents, based on the National Longitudinal Study of Adolescent Health, 30 percent of the parents of obese teenagers correctly identified them as obese. (Obesity was defined as the top 5 percent of BMI.) Teenagers were even less accurate when describing themselves: nearly one half of the teens who reported that they were overweight were not obese according to their BMI, but only 6 percent of obese teens correctly categorized themselves as obese. Youth workers will not be surprised to hear that girls of normal weight were more likely than boys to mistakenly believe they were very overweight.

The Academy of Pediatrics urges pediatricians to do a better job of telling parents to be concerned about obese children. Other family members, youth workers, and other adults who spend time with obese children have a different but equally important role: minimize temptations for kids to eat fattening, unhealthy foods; provide healthier, lower calorie foods; and help parents become aware of the health risks, teasing, and other social risks that an obese child experiences.

References:
Parents of Obese Children Don't See Them As Fat
Miriam Tucker
Pediatric News
July 2000
Available free from Joanne Berger at Pediatric News (800) 445-6975

Accuracy of Teen and Parental Reports of Obesity and Body Mass Index
Elizabeth Goodman, M.D., Beth Hinden, Ph.D., and Seema Khandelwal, M.P.H.
Pediatrics
July 2000, Vol. 106, No. 1
Available from Dr. Goodman at Children's Hospital Medical Center, PAV-2129, 3333 Burnet Ave., Cincinnati, OH 45229
or goode@chmcc.org

Girls and Weight Control: Let Them Eat Cake?

Do girls who try to lose weight tend to gain weight instead? A new study suggests that adolescent girls who try to lose weight are more likely to gain weight and to become obese, compared to girls who do not try to lose weight. This study has important implications for adolescent girls, parents, and youth workers, since one of every four adolescent girls are obese and so many girls are obsessed with issues of appearance and weight.

The researchers studied 692 ninth-grade girls from different ethnic groups in northern California for four years. The average girl was almost 15 years old when the study began. The girls gained an average of three pounds each year, regardless of whether they were overweight, underweight, or of normal weight when the study began.

The girls' efforts to control weight seemed to backfire, and the researchers believe this may be because the girls' efforts were so often misguided. Girls who used appetite suppressants, laxatives, self-induced vomiting, or engaged in binge-eating were especially likely to gain weight. Girls who said they were "dieting" were slightly more likely to gain weight.

The study also evaluated which girls became obese. Of the 589 girls who were not obese in ninth grade, 63 (11 %) had become obese by the study's end. Like

weight gain, obesity was more likely among girls who had tried to control their weight. Girls who dieted were more than three times more likely to become obese than girls who did not diet. Girls who reported exercising to control weight were also more likely to become obese. Girls who used more appetite suppressants and laxatives were even more likely to become obese.

According to the researchers, young women who strive to lose weight are more likely to "progress to" binge eating and subsequent weight gain. Adolescents

with a family history of obesity may start weight-control efforts early as they try to avoid becoming overweight, but their weight control efforts do not necessarily involve decreasing fat intake or calories or increasing exercise. It is difficult to evaluate what they are eating because kids' reports of food consumption and exercise levels are notoriously inaccurate.

Eric Stice told me that he is still trying to make sense of the study findings. One possible explanation is that when you diet, you no longer pay attention to when your body tells you to eat. Then, when you get really hungry from lack of food, there is a tendency to overeat. Stice isn't convinced that is what is going on here, especially since exercise was not beneficial, as expected. He suspects that some people have a chronic tendency to overeat more calories than they need, and although they say they are dieting or exercising, they aren't doing enough to make up for their overeating. The more extreme efforts, such as laxatives and vomiting, just

make matters worse.

Dr. Stice advises efforts to "engage kids in a weight control lifestyle" whenever possible. "Most weight control efforts aren't healthy, but if kids make healthier choices about their eating and exercise, that would be a wonderful thing. Remind kids that it's much easier to prevent weight gain than to lose weight."

Reference:

Naturalistic weight-reduction efforts prospectively predict growth
in relative weight and onset of obesity among female adolescents.

Eric Stice, Rebecca Cameron, Chris Hayward, C. Barr Taylor, Joel Killen

Journal of Consulting and Clinical Psychology

December 1999, Vol 67, pgs 967-974.

Free copy from stice@psy.utexas.edu or write to Eric Stice at Dept. of

Psychology, U of Texas at Austin, 330 Mezes Hall, Austin, TX 7871

Couch Potatoes Beware

The debate about the impact of TV violence continues, but meanwhile, there is growing evidence that TV viewing contributes to children’s obesity, which is on the rise among children of all ages.

Overweight children are often teased and sometimes humiliated by other kids, which can make their lives miserable. This very solid study of more than 4,000 boys and girls between 8 and 16, finds that obesity is twice as likely among kids who watch four or more hours of TV per day (16 percent), as it is among those watching one hour or less per day (8 percent).

Kids who watch more TV probably have less time for physical activity, but that does not seem to be the reason for this link between TV and obesity. Surprisingly, there was no evidence that vigorous physical activity prevented obesity. However, kids -- especially girls -- who watched more TV tended to consume more calories.

How much TV do these kids watch? Almost half watches more than 2 hours a day, and the boys watch more TV than the girls. Most African American and Mexican American children watched more than 3 hours per day, compared to 37 percent of non-Hispanic white kids. Blacks were the heaviest TV viewers: 17 percent watched 5 or more hours each day, compared to 9 percent of Mexican American and 6 percent of whites.

Boys were more physically active than girls, on the average, and white boys were most likely (72 percent) and African American girls were least likely (42 percent) to participate in physical activity at least 5 days each week.

TV viewing was related to obesity even when other potentially important factors were statistically controlled: Girls who watched more television were more likely to be obese, regardless of their weekly physical activity, energy intake, age, race/ethnicity, and family income. However, this was not true for boys.

The study was based on the NHANES III, a survey conducted by the Centers for Disease Control and Prevention, which includes a home interview and medical examination of a nationally representative sample of children and adults. They did not evaluate how much time the children spent in front of a computer. However, the data were collected between 1988 and 1994, before computers were as popular among children as they are today. It is certainly possible that the popularity of computers has led to a decrease in TV viewing.

Since TV viewing, eating, and sports are major components of most children’s daily lives, this study has important implications for youth workers. How often are TV programs, videos, and films used as part of recreation programs, daycare and after school programs, and even school programs and homework assignments? In contrast, how often do youth workers encourage youth, or their parents, to spend less time in front of the TV or to avoid eating while watching TV? This study suggests that parents need to realize that sitting (and eating) in front of the TV contributes to obesity, and do more to limit TV viewing and encourage alternative activities.

Reference:
Television Watching, Energy Intake, and Obesity in US Children
Carlos Crespo, Ellen Smit, Richard Troiano and colleagues
Archives of Pediatrics and Adolescent Medicine
March 2001, Vol 155, pages 360-365
Available free from Dr. Crespo at School of Medicine, SUNY at Buffalo,
270 Farber Hall, Buffallo NY 14214 or ccrespo@buffalo.edu

Brain Development:

Does Early TV Viewing Cause ADHD?

Why are there so many kids with attention deficit disorder with hyperactivity (ADHD) compared with 40 years ago? Could it merely be that we are recognizing a problem that used to be undiagnosed, or is there a real increase?

An April 2004 study linking TV viewing and ADHD took me by surprise. It raises important issues for all parents and child care workers.

There is a huge pile of research indicating that watching TV is linked with negative behaviors in children, and I have been concerned about the negative influences of TV on kids attitudes and behavior since I conducted research on elementary school children in 1978. But, like most psychologists, I thought the problem was that children were “learning” bad things from what they watched. I never thought about the impact on the “wiring” of the developing brain, which is the premise of this study.

The researchers point out that compared with the pace of real life as experienced by young children, TV can portray “rapidly changing images, scenery, and events.” It is very interesting to children, but may be overstimulating as well. Pediatricians warn against TV viewing for children under the age of two, but TV is a convenient babysitter, and young children are exposed to it in most homes and many family day care centers.

This article in Pediatrics is based on data from the National Longitudinal Survey of Youth (NLSY) 1979, which started with a nationally representative sample of more than 12,000 youth between the ages of 14 and 22 in 1979. The participants have been interviewed every other year ever since. Starting in 1986, more than 11,000 children born to the women in the original study were also included. This article is based on a study that followed more than 2,500 of those children, starting from ages one or three to age 7.

Starting in 1990, mothers were asked the number of hours of TV their children watched on typical weekdays and weekends. Half of the children were male and 57% were white.

The children watched an average of 2.2 hours of TV every day at age one and 3.6 hours at age three. However, the range of TV viewing was skewed, especially for one-year olds, with almost half the moms reporting that their infants watched TV less than one hour per day and about 10% reporting that their infants watched five hours or more per day.

Ten percent of the children had attention problems at age 7, based on the hyperactivity subscale of the Behavior Problems Index. This subscale consists of five questions about having difficulty concentrating, being easily confused, impulsive and restless, and having obsessions. Although not the same as a diagnosis, these questions are from the Child Behavior Checklist, and other studies show that most children with these reported problems are diagnosed with ADHD.

Because parents who allow young children to watch many hours of TV each day may have other shortcomings, the researchers controlled for prenatal substance abuse, gestational age of the child, the mothers’ mental health and socio-economic status. Even when those traits were statistically controlled, infants and toddlers who watched more TV were more likely to have attention problems at age 7.

The children who had attention problems only watched a little more TV than the other children, on average. But some children in the study watched 8 hours or more of TV each day, and when you look at the extremes of TV viewing, the results are startling. For each additional 3 hours of daily TV viewing, a child was 28% more likely to have attention problems.

One shortcoming of the study is that TV viewing was estimated by the mothers, who might have been inaccurate or less than candid. Likewise, mothers who let their young children watch excessive amounts of TV could be neglectful or have other traits that were not statistically controlled.

Another problem is that the type of TV programs viewed was not evaluated. This study couldn’t determine whether some TV programs were more strongly associated with attention problems than others. But four-plus hours of TV each day is probably not good for infants and toddlers’ brain development no matter what the programs are.

Reference:

Early Television Exposure and Subsequent Attentional Problems in Children
Dimitri Christakis, M.D., M.P.H., Frederick Zimmerman, Ph.D., David DiGiuseppe, M.Sc., and Carolyn McCarty, Ph.D.
Pediatrics, Vol. 113, No. 4, April 2004, pgs. 708-713.

Mom was Right: Teen Brains are Different

Adolescent brains really are different from adult brains, and the differences may explain the impulsiveness and aggression that are more typical of the teenage years, according to Deborah Yurgelun-Todd, PhD, speaking at a recent meeting on adolescent self-destructive behavior sponsored by Cambridge Hospital in Massachusetts.

The neural activities of the brains of 15 adolescents and 15 adults were compared using magnetic resonance imaging (MRIs) during a facial recognition task and a word production task. Compared with adults, the teenagers' brains seemed to have less functional activity in the frontal cortex, which is the part of the brain that organizes and modulates behavior. Instead, teenage brains were more active than adult brains in the amygdala, which is responsible for associating external sensory stimuli with emotions.

The study supports a biological explanation for the differences between teenagers and adults, according to Dr. Yurgelun-Todd, who is director of cognitive neuroimaging and neuropsychology at McLean Hospital in Belmont, Mass. In addition to the differences in brain activities, teenagers were more likely to misread facial expressions than adults. This could potentially cause problems in interpersonal relationships, according to Yurgelun-Todd.

Although the study is small and should be considered preliminary, it is the second recent study showing how teen brains differ from adults. These studies remind us that the biological changes of adolescence are an important influence on some of the behaviors that are so difficult to control or understand.

Reference:
Teen Brains Have Less Frontal Cortex Function
Kim Lawson
Clinical Psychiatry News 28 (5): p. 41, 2000

Message from Teen Brains: It’s Not Too Late!

A recent article in the Washington Post caught our eye: "Scientists have discovered that the brain undergoes surprisingly dramatic anatomical changes between the ages of 3 and 15, a finding that may not amaze parents of mercurial children but shatters some traditional assumptions about neural development." It’s a good thing that the mass media picked this story up, because the original article is much less useful to most of us. It concluded: "By repeatedly scanning children (ages 3-15 years) across time spans of up to four years, a rostro-caudal wave of growth was detected at the corpus callosum, a fibre system that relays information between brain hemispheres."

Fortunately, one of the authors, Dr. Jay Giedd from the National Institute of Mental Health, was glad to translate these findings for us. He thinks the results of this study are very important for parents and other adults who care about children, and very good news for adolescents. The bottom line is that the activities that youth engage in will influence how their brains work for the rest of their lives.

We already knew that a first grader’s brain is approximately 95% of the size of the adult brain, Giedd explained. But the size of the brain is not the only important factor. Apparently, the brain uses a clever way to wire itself: It overproduces cells and connections, and then there is a fierce battle to survive. "We thought this occurred in the womb and the first 18 months of life," Giedd explained. "We were really surprised to see a second wave of overproduction just before puberty, peaking around age 11 in girls, and 12 in boys."

"The guiding principle is ‘use it or lose it,’" according to Giedd. The brain connections that are used will survive, and those that aren’t used, won’t. Kids who are actively participating in academics, music, or sports will "wire" their brains to be better at those activities in the future. On the other hand, coach potatoes beware - passive TV viewing and sitting around doing nothing will have long-term detrimental effects. Giedd points out that drugs and alcohol are especially dangerous at this pre-puberty time than later in life, because the brain is most vulnerable. "Huffing" of glue and inhalants, which is most common form of abuse at this age, is possibly the most dangerous.

What about kids who seem to care about nothing but the opposite sex and clothes? The surprising answer was that attracting the opposite sex is a big part of what the brain is wired for. (For boys, interest in sports is part of the mating ritual.) These interests are natural, and don’t harm brain development. In fact, Giedd reassured us, human relations are challenging and complex, so that kind of brain activity is very stimulating and important. For example, dealing with interpersonal relationships is much more complicated than even the most complex video games. Participating in sports can help "wire" coordination and other skills that will enable a youth to grow up to be a star athlete. Developing musical skills at this age can also have life-long consequences. Giedd points out that this may be the reason why Olympic athletes and famous musicians have usually started at an early age.

Reading is another great activity for developing brains, because it requires so much activity: relying on memory, predicting what will happen next, and other generic activities are probably much more important than the actual content. It’s a good time to learn a new language, as well. Watching TV and movies can also be stimulating if it requires complex thinking rather than passive viewing.

The brain research is at a preliminary stage, so important questions like the impact of exposure to violence can’t be answered. But Giedd emphasizes that the important message is that youth workers should encourage kids to take advantage of the opportunity to "optimize their brains." "Our first opportunity to do this – as infants – is out of our hands, dependent on our parents and caretakers. Kids can feel empowered knowing that they have another chance, and it’s up to them to make the most of it."

Reference:
Growth Patterns in the Developing Brain Detected by Using Continuum Mechanical Tensor Maps
Paul M. Thompson, Jay N Giedd, Roger Woods, et al
Nature, Vol 404, March 9, 2000
Free copy available from Dr. Thompson at thompson@loni.ucla.edu

These articles are based on Diana Zuckerman's monthly Research Watch columns that appeared in Youth Today in issues from November 1999 through March 2003, and were reprinted with permission. Youth Today is a publication of the American Youth Work Center, 1200 17th St., NW, Washington, D.C. 20036. (800) 599-2455. E-mail: youthtoday@aol.com

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