The nation’s children — indeed, the world’s — are fatter than ever, with no end in sight to their increasing girth, and unless something is done now to reverse this trend, the health costs, already very high, will be astronomical in the not-too-distant future. One-fourth of all school-age children are now overweight and one-eighth are obese, twice the proportions found just two decades ago. From the late 1980’s to the late 1990’s, the prevalence of overweight children increased by more than 50 percent among whites and more than doubled among African-American and Hispanic children, making excess weight the most common health problem now facing American children. Obesity is a risk factor for four of the 10 leading causes of death in this country: heart disease, diabetes, stroke and cancer. And, it accounts for more than 300,000 premature deaths each year and direct health care costs in excess of $61 billion. Research has shown that at least half of obese children over 6 and 70 percent to 80 percent of obese adolescents become obese adults. The causes are multiple and the solutions will have to be as well. They include the home, day care, schools, advertising, restaurants, convenience stores, vending machines, malls and movie theaters. We are living in what Dr. Kelly Brownell, an obesity expert at Yale, has called “a toxic food environment.” In it, people from infancy on are continually tempted to eat too much of the wrong foods. Even if the foods were healthful, the increase in portion sizes alone would account for rising weights. In its Nutrition Action Healthletter last year, the Center for Science in the Public Interest cited the changes in offerings to document the “serving-size sprawl” that has prompted people to eat more food than they need to be satisfied.
In the 1950’s and 1960’s, a serving of French fries, at 200 calories, weighed about two ounces; in the 1970’s, a 320-calorie large size was introduced; in the 1980’s, large became medium and the new large had 400 calories, growing to 450 calories by the mid-90’s when the super-size was introduced at 540 calories, which is now the large size with the super-size at 610 calories.
Contrast the original McDonald’s meal of burger, fries and 12-ounce Coke at 590 calories with one of today’s super-size value meals — a quarter-pound cheeseburger, super-size fries and super-size Coke at 1,550 calories, and it is easy to see why so many young people overeat. McDonald’s is hardly alone in this trend. Restaurants throughout the country are offering ever-larger portions, and most diners eat what they are served.
Compounding dietary sins is a widespread decline in physical activity, in school and out, as budget-driven schools cancel athletic programs and children after school forgo bicycles, balls, jump-ropes and skates for television, computers and video games. Twenty-six percent of children from 8 to 16 watch four or more hours of television a day, and the proportion of high school students who participate in daily physical education classes dropped to just 29 percent in 1999 from 46 percent in 1991.
Start Dietary Lessons Early
Children learn to like what they are accustomed to eating and what they see others eating. Though this may sound self-evident, parents these days do not seem to realize it.
If the family breakfasts on rice and beans (à la Costa Rica) or soup and fish (à la Japan), the children will grow up preferring these to cinnamon rolls or bagels and cream cheese. And, of course, if eating breakfast is a household norm, children will join in. Children who regularly eat breakfast are more likely to consume the day’s quota of essential nutrients and fiber.
It is normal for young children to reject foods that are different, but if those foods are regularly offered, they eventually becomes familiar and accepted. It is also normal for small children to learn to hate foods that are forced on them and to love foods that are used as rewards or enticements. Better not to attach any emotional content to any food.
To learn how much food satisfies them, children must be allowed to determine when and how much they eat. The more control parents try to exert, the less likely children will learn to listen to their internal cues of hunger and fullness.
Mealtime should never be a contest of wills, with the adults trying to control the time, amount or type of food a child eats, assuming that what is offered is reasonably nutritious.
Furthermore, a child’s tastebuds can be programmed, in a sense, to prefer foods that are less sweet, less salty and less greasy than the fare most Americans now consume to excess. A cracker or tea biscuit or frozen yogurt can be as much of a treat for a toddler as an ultrasweet Girl Scout cookie or calorie-rich Häagen-Dazs ice cream. My own sons are a case in point: having been reared on homemade muffins and quick breads made with half the usual amount of sugar and fat, at age 10 they rejected a rich chocolate cake as being “too sweet” and to this day — at age 32 — do not enjoy very sweet, rich desserts.
Children, as they grow up, will eat whatever is handy, so what parents have in the house can make a big difference. If cookies, chips, ice cream and soft drinks are what are available, those are what they will eat. But if fresh fruit or a fruit salad, flavored yogurt, low-fat bran muffins, fruit juice and low-fat or skim milk are what they find, they will probably use those to satisfy their hunger between meals. At the same time, it is wise not to be so dogmatic as to make certain foods forbidden, since this will only make those foods more desirable and encourage behind-your-back cheating. When our sons were young, we paid occasional visits to fast-food restaurants, we gave them money for candy once a week, and they could order soda when we dined out and eat sugary cereals for breakfast when they slept at friends’ homes.
Work With the Schools
Parents need to pay more attention to the health lessons schools offer. There are three pernicious trends in schools today: vending machines that dispense soda and candy (by “bribing” schools to install them, usually in or near the cafeteria); school lunches that are riddled with fat, often from well-known fast-food companies; and a steady decline in in-school and after-school physical activities suitable for children at all levels of ability. Under pressure to increase academic scores as budgets dwindle, school districts are eliminating the kinds of activities that nourish bodies and souls. But schools need to be reminded that sound minds operate best in sound bodies. Schools should be urged to create or reinstate sports programs. At the same time, parents must encourage physical activity outside the schools. Firm limits should be placed on the amount of time children spend watching television or playing video games.
A good rule is “when it’s light out, you’re out” — outside playing. Whenever possible, participate in activities with your children — cycling, hiking, swimming, playing ball, skating — to establish movement as a family norm.