José Amaya understands how hard it is for kids to lose weight.
José was 10 when his pediatrician told him he was overweight and suffered from a condition known as fatty liver. He sent José to the weight-management program at Nicklaus Children’s Hospital in Miami, where the program’s director, Dr. William Muiños, put him on an eating and exercise regimen.
“It’s hard to adjust to a new diet, especially with school and other things in your life,” said José, now 14. “I’ve had ups and downs.”
At six foot four inches, José said he’s “on the right track now,” walking and exercising more. He still goes to the weight program to monitor his liver, which improves with a healthier diet. José said he’s eating salads, substituting Greek yogurt for sugary cereals and eating chicken and veggies instead of a burger and fries. Nuts have replaced candy and chips.
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“I would tell kids to stick with it,” José said.
But too many kids are veering off track, struggling with weight issues for years.
“It’s really an epidemic,” said Muiños, a pediatric gastroenterologist.
About a third of children ages 2 to 19 are overweight and half of those are obese, Muiños said. The numbers are even higher in African American and Hispanic communities, where nearly 40 percent of children are overweight or obese, according to first lady Michelle Obama’s Let’s Move initiative.
The Centers for Disease Control reports that the percentage of U.S. children aged 6-11 years who were obese increased from 7 percent in 1980 to nearly 18 percent in 2012. The percentage of adolescents aged 12–19 years who were obese quadrupled during this time, from 5 percent to nearly 21 percent.
Muiños said he sees about 30 children a week at the Nicklaus weight program. “We’re seeing an increase in Type 2 diabetes,” he said. “That used to be adult-onset diabetes. Now we see it in kids 8 or 9 years old.
“These kids are eating large and enormous densely rich food with fat and starch and more starch than anything else,” he said.
Some parents don’t recognize or acknowledge that a kid is obese until health issues appear. Symptoms of Type 2 diabetes in children include increased thirst and urination, fatigue and a darkening of skin around the neck. Experts caution that children and teens who are obese can also face heart disease, high blood pressure, sleep apnea, cancer and asthma. On a psychological level, they can be bullied and have low self-esteem.
For a child who is overweight, the focus is making better decisions and slowing weight gain rather than on dieting. This way the child grows into a healthy weight, said Cathy Clark-Reyes, a registered dietitian with Baptist Health Primary Care. “If the child is obese, additional intervention is necessary.”
Why has the problem escalated?
“The reasons are very deep and entrenched in the way our society operates,” said Sarah Hart-Unger, a pediatric endocrinologist at Joe DiMaggio Children’s Hospital in Hollywood, part of Memorial Healthcare System. “Kids are spending a lot of time indoors, playing video games and watching TV. And some parents are putting the child on auto pilot.”
The American Academy of Pediatrics reports that kids get an average of seven hours of screen time per day. They should be limited to one to two hours per day and less for tots under age 2.
When devising a plan for a child to reach a healthy weight, Muiños said he looks at several factors, including a kid’s diet in and out of school, activity level, how much time is spent with a computer or TV and the amount of sleep a child gets.
A lack of sleep “puts the body in a stress mode and it holds onto calories,” Muiños said.
Some kids— especially with parents who work long hours — don’t play outdoors.
“I grew up in Miami-Dade and I would walk 12 blocks to middle school,” said Penny Parham, administrative director of the Department of Food and Nutrition for Miami-Dade County Public Schools. “We’d ride our bikes and play outside. But there are places in town where kids can’t go outside. There are some dangerous streets. And sometimes the park isn’t safe. And we tell our kids now, ‘You can’t ride a bike — someone might hit you with a car.’ It’s not the same.’’
Among nutritional challenges, Hart-Unger sees three chief culprits:
▪ Sweetened beverages are ubiquitous, including sodas, sports drinks, sweet tea, fruit drinks and juices. “They’re pretty much toxic for kids,” she said.
▪ Marketing of highly processed, high-sugar foods to children, particularly sugary cereals and snacks and fruit drinks.
▪ Portion size: “We’ve lost touch with portion size,” Hart-Unger said.
And there’s an all-too familiar scenario. “When I was a kid, going out to eat was rare,” Clark-Reyes said. “Now busy parents or caregivers stop by fast food drive-thrus on the way home and load up on burgers and fries “
Even grocery shopping is more of a challenge for parents. “Grocery stores used to be smaller with not as many products,” Clark-Reyes said. “Now just the cereal aisle has hundreds of products.’’
And just because it’s cereal doesn’t mean it’s healthy. “Every kind of junk food goes into cereal these days — cookies, chocolate. And they’re loaded with sugar and salt,” she said.
Start giving a tot sugary and salty foods, and it becomes a taste they crave, an ingrained habit, Muiños said.
“We know the cure — it’s getting people to change their behavior. But it has to be a forever lifestyle change,” said Sarah Messiah, a research associate professor of pediatrics at the University of Miami Miller School of Medicine.
When kids are small, “parents have 100 percent control” over what food is served and stocked at home. “It’s not the children driving to the grocery store or making nutrition choices for the family,” Messiah said.
A key to preventing childhood weight issues is reaching kids and their parents early on, the chief reason University of Miami medical school researchers are putting a major focus on preschools. The university has received a three-year, $1.7 million grant from the USDA to institute nutrition and exercise education in low-income Miami-Dade preschools, aiming at 2 to 5 year olds, Messiah said.
The new project follows a previous UM grant that studied the effect of a childhood obesity prevention program in 28 Miami-Dade preschools. With this new grant, which gets underway in 24 childcare centers in August, UM researchers and the USDA will focus on educating preschool operators and teachers to ensure they incorporate nutrition and exercise into their center.
“The first two years, it’s in schools in the urban core,” Messiah said. “The third year, it will go into 400 schools all over the county.”
Researchers will teach preschools how to serve healthier foods without raising costs, and offer parents once-a-month dinner sessions to show them how to make changes at home.
“It’s all about introducing foods to kids,” Messiah said. “If you tell little kids broccoli is the best thing you’ll ever eat, they’ll believe it. It sounds silly but it’s the truth.”
One of the big changes: replacing sugary drinks and snacks.
Aside from sugar, “there’s so much stuff in sports drinks,” Messiah said. “Artificial coloring and flavoring. A lot of research is showing that kids are having sensitivity to yellow, blue and red dyes. As much as you can, stick with water.”
Instead of sugary and fat-laden snacks, kids should have “a piece of fruit, a bag of nuts, low-salt, high fiber chips or crackers,” she said. Preschools, for instance, would serve fresh fruit instead of canned peaches in syrup.
Miami-Dade and Broward schools have also been working to overhaul their menus to offer more healthy choices, particularly after the Let’s Move initiative from Michelle Obama.
Changes include removing hot dogs and corn dogs from the menu, offering a salad as a side or entree daily (some schools have salad bars) and ensuring every meal includes a cup of fresh fruit or vegetable. Sodas and sweetened drinks have been removed from vending machines.
It’s not easy getting kids to make the switch, Parham said, but there is progress. The most popular lunch item now is Asian- glazed chicken with baked white meat, brown rice and veggies. Green beans and corn comes from a farm near Lake Okeechobee.
“They’re not getting an oversize basket of french fries in school,” Parham said.
Most of all, losing weight takes commitment from the whole family, experts said.
“Parents will say that when they start making changes for their child, they lose weight too,” Hart-Unger said. “It helps everyone.”
Tips for a healthier lifestyle
▪ Prepare a healthy meal that includes at least one thing that everyone will eat. A healthy diet means five daily servings of fruits and vegetables along with whole grains, lean protein and dairy. “Keep in mind that it takes several tastes before a child likes the food being offered,” Baptist’s Cathy Clark-Reyes said. “Do not give up!”
▪ Get your child involved in the shopping and cooking.
▪ Don’t ban all treats, rather minimize a child’s access, said Sarah Hart-Unger of Joe DiMaggio. Take them out for ice cream or an occasional burger but don’t keep ice cream at home.
▪ Teach your child how to eat moderately rather than forbidding foods.
▪ Avoid cereal and milk as a bedtime snack, because so many popular brands are high in sugar and carbs.A better bedtime snack would be a salad, banana or a few slices of turkey and a vegetable. Also, substitute skim milk for regular or 2 percent milk.
▪ Read labels carefully. Some snacks are marketed as healthy but have a lot of sugar, salt or fat.
▪ Offer water or diluted fruit juice for thirst quenching. Sports drinks are unnecessary unless the child is involved in more than one hour of strenuous exercise.
Sources: Baptist Health, Nicklaus Children’s Hospital