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June 4, 2009 – Vol. 3 • No. 10
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The ABCs of BMI

In many ways, Dante White is a typical 16-year-old boy. He likes football and basketball, and every now and then, enjoys picking up a brush and trying his hand at art.

White also readily admits that he likes to eat — Italian dishes, in particular.

“I like lasagna, spaghetti — any kind of pasta,” the ninth-grader said.

But two years ago, he started to eat “a little too much.”

He should have known better. A borderline diabetic, White had been told to watch his weight to avoid increasing his medical risks.

“I was eating a lot,” he said. “I had blurry vision … I was dehydrated.”

He was soon diagnosed with type 2 diabetes.

“It’s hard,” Dante said. “I used to eat wrong.”

Dr. Shikah Anand has a particular interest in children like Dante who are struggling with their weight.

As director of pediatrics at Whittier Street Health Center, she is troubled by what she is seeing. More and more children have high blood pressure, type 2 diabetes and high cholesterol — all preventable cardiovascular conditions that are related to obesity.

But Anand does have some encouraging news.

“Children are more educated and ready to make changes,” she said. “There is an increased need to do something about it.”

The “it” refers to childhood obesity, a problem that has received national attention in recent years. In 2001, for instance, then-U.S. Surgeon General Dr. David Satcher issued a warning on the growing tide of obesity. If not checked, he cautioned, obesity would soon overcome smoking as the leading preventable cause of death.

Apparently, his warnings fell on deaf ears. The Centers for Disease Control and Prevention (CDC) determined that in 2008, more than 63 percent of all U.S. adults were overweight or obese. More troubling is the youthfulness of the epidemic.

Between 1976 and 2006, the prevalence of obesity more than doubled in children ages 2-5 and 6-11, and more than tripled in adolescents ages 12-19.

The prevalence of obesity varies by race and ethnicity. About 22 percent of Mexican American children and adolescents are obese, compared to 18.5 percent of blacks and 17 percent of whites.

The problem starts early. A recent study published in the Archives of Pediatric Adolescent Medicine found that among five major ethnic groups of 4-year-olds, American Indians were hardest hit, followed by Hispanics and blacks.

As in adults, obesity in children is determined by the body mass index, or BMI, a measure of weight in relation to height. Unlike the BMI for adults, the measurement for children is plotted on CDC growth charts and is age- and -gender-specific, because the body’s composition changes with age and differs between boys and girls.

Overweight is defined as a BMI-for-age between the 85th and 94th percentile, while obesity is defined as a BMI-for-age at or above the 95th percentile.

Interpretation of the BMI is a bit tricky. If a child is in the 80th percentile, for example, that means that compared with other children of the same age and sex, 80 percent have a lower BMI.

Overweight children are at higher risk of developing high blood pressure, high cholesterol and type 2 diabetes — all previously considered adult conditions.

According to the CDC, in one population-based study of 5- to 17-year-olds, 70 percent of obese children had one cardiovascular risk factor and 39 percent had two or more.

Cardiovascular diseases are not the only medical threats. Asthma, sleep disorders and even liver disease are other possible consequences.

Emotional problems are common as well. Heavy kids are often bullied or teased about their weight. Some suffer from anxiety and learning difficulties. Many are depressed.

More distressing is that obesity and its concomitant illnesses often continue into adulthood. Several studies have demonstrated a correlation between adult and child obesity. One study found that the age at which obesity was diagnosed is a factor — if a child is diagnosed as overweight before the age of 8, adult obesity is more severe.

Another concern is the misperception of weight problems. A study from McGill University in Montreal found that kids and teens surrounded by overweight family members and classmates are more likely to be unaware of their burgeoning waistlines. Underestimation of obesity was found in both sexes and among all socioeconomic backgrounds.

The underlying cause of weight problems is straightforward — more calories are consumed than used. The reason behind this imbalance is more complicated. The biggest culprit is diet — sugared soft drinks, fast foods and high-fat and salty snacks all contribute to excess pounds. Eating more meals away from home and super-sized portions of empty calories add to the problem.

Inactivity is another cause. In its 2008 Physical Activity Guidelines for Americans, the U.S. Department of Health and Human Services recommended that children and adolescents get 60 minutes or more of physical activity each day, including both aerobic and muscle-strengthening exercises.

The benefits of exercise are well documented. It helps build strong bones and muscles, allows better sleep and provides a healthier outlook on life. And it reduces the risk of cardiovascular diseases.

Yet children, for many reasons, do not get the required minimum activity.

As Anand rightly concludes, “The first line of attack is lifestyle change.”

Anand runs Whittier’s healthy weight clinic for children, as well as Run Around Roxbury (RAR), a program to address weight management through nutrition education, exercise and emotional support. In addition, participants receive regular screenings, BMI tracking and risk assessments for obesity-related illnesses.

White is a regular member of RAR. Though he is on medication to control the diabetes, he is not leaving anything else to chance.

And he said he actually likes the program. He’s learning what to eat and what not to eat. He loves the hip-hop dancing and kickboxing. He participates in the cooking class and meets one-on-one with the nutritionist.

Dante says he is looking at the bright side — at least he is learning to cook healthier meals.

His mother, Angela, is also in the mix. She knew she had a weight problem herself and takes an active role in meeting with the nutritionist as well.

“It gives me an idea of what to cook and how to cook it,” she said.

Laneah Holloway (front) and Jonathan Arias enjoy kickball during recess at Mission Hill K-8 School. Rubbie Lerbours is in the background. Regular physical activity can help prevent excessive weight gain in kids.

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