The new American Academy of Pediatrics guidelines for childhood obesity have shifted from a “watchful waiting” method to “early and aggressive treatment.” Recent coverage of the guidelines in The Seattle Times and other reputable news outlets has recognized this new understanding of childhood obesity as a disorder in need of immediate, aggressive intervention, but has given little attention to what has been proven to help keep kids healthy — a nutritious diet and healthy lifestyle habits.
Body size is complex and influenced by a multitude of factors. According to the Centers for Disease Control and Prevention, obesity in children ages 2 to 18 is defined as a body mass index above the 95th percentile. The average body size and weight in humans in the United States has significantly increased over the past 60 years, which means more adults and children fall into categories defined to be overweight and obese. There has been much pressure on medical organizations to “fix” the problem of increasing body weight, but I believe our perspective and approach have been all wrong.
Emphasizing body size, especially in children, is unlikely to help us achieve our ultimate goal for our patients — promoting health, well-being and longevity. Drugs and surgery in young children address only one symptom. However, it tends to undermine root causes, which is what is truly driving our skyrocketing incidence of chronic diseases, conditions such as cardiovascular disease, diabetes, dementia and early mortality.
The answers lie in the practice and promotion of lifestyle medicine, systemic changes to our food supply and availability, intuitive eating practices and a de-emphasis on body size as the determining factor of health and well-being.
According to a study in the American Journal of Clinical Nutrition, a diet rich in vegetables, fruits, legumes and whole grains is associated with lower body weight in children, which is associated with a decreased risk of chronic disease. Decades of research show that this type of healthy, plant-based eating can help prevent, improve and even reverse type 2 diabetes. The American Diabetes Association even endorses a plant-based diet.
A low-fat, plant-based diet also lowers the risk of heart disease in children by improving their blood pressure and cholesterol levels, according to a Cleveland Clinic study. That’s critical as some children now show evidence of significant heart disease beginning as young as age 8! And half of US children and adolescents do not have ideal cholesterol levels, with 25% in the clinically high range.
I have seen firsthand in my pediatric practice the difference diet and lifestyle modifications can make for the health and well-being of children and their entire family. My goal is not to mold children into a certain body size but to provide all the education and tools to live a long and healthy life through health-promoting habits and behaviors.
Some tips I share with parents to encourage the adoption of health-promoting eating habits include:
• Teach children the value of good nutrition and that food is a fuel for health and well-being. There are no good and bad foods, but some foods are higher in nutrient density and fiber.
• Have healthy foods readily available for meals and snacks, for example hummus and crackers, or a fresh or frozen fruit smoothie.
• Follow a flexible schedule for meal and snack times and support children as they learn to listen to natural hunger and fullness cues, rather than focusing on “cleaning plates.”
• Engage children in the food preparation process.
While diet is not a panacea, the mention of prevention and dietary interventions that work to reduce the risk of chronic disease should be a part of any reporting on childhood obesity.