- The Washington Times - Tuesday, August 20, 2002

Growing up in a New Jersey suburb near New York City, John Jenkins carried around a few extra pounds. The certified personal trainer with Georgetown's Definitions gym says his Southern-bred parents didn't know the nuances of a nutritionally sound diet back then.

The young Mr. Jenkins did have something many of today's area children don't have a safe place to run, play and work off at least some sugar-laden snacks.

His parents would tell him to play in the yard and "come back when it's dinnertime," Mr. Jenkins says.

Not every child in the area has that luxury. Diminishing room to romp is one of the reasons, experts say, that our children are getting heavier.

The number of overweight children and adolescents has more than doubled since the early 1970s, according to the Centers for Disease Control and Prevention (CDC). The center, in Atlanta, adds that about 13 percent of children and adolescents are considered seriously overweight.

Obesity is inferred from a person's body-mass index (BMI), calculated by dividing weight in pounds by height in inches, dividing that figure again by height in inches, and multiplying that figure by 703.

A BMI level of 25 or more is considered overweight, while 30 or more classifies the person as obese.

Tracking a child's BMI is a bit more difficult because body frames and growth spurts can differ. Doctors calculate a child's BMI, then plot the results on a BMI curve used by the CDC. If that point falls between the 85th and 95th percentile on the chart, meaning the child weighs more than 85 to 95 percent of other children, he or she is considered obese.

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The complications of obesity in children are manifold.

Heavy children risk cardiovascular and respiratory problems, hypertension, sleep apnea, gastrointestinal problems and type 2 diabetes, a condition once confined primarily to adults. The latter can lead to blindness, kidney failure, loss of limbs, heart disease and sometimes death.

A doughy physique also opens a child to ridicule.

"I've had parents who come to me and said, 'I'm concerned. My son or daughter is among the biggest kids in the class, and they're starting to get teased,'" Mr. Jenkins says.

Children may forget the taunts. They may not let go of the weight.

Eating and exercising patterns begun in childhood too often remain etched in a person's behavioral patterns for a lifetime. The surgeon general's office reports that 70 percent of overweight adolescents will become overweight or obese adults. The CDC also reported earlier this year that hospital costs tied to childhood obesity have more than tripled, totaling $127 million by 1999.

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To help area children stay fit and trim, Mr. Jenkins runs Just for Kids, an hourlong program he began three years ago.

Exercises including "Red Light, Green Light" involve rapid running and stopping movements.

Adults may need prodding to work out properly, but Mr. Jenkins says he keeps the attitude more relaxed around youngsters.

"I'll tell parents, 'I'm not going to force the kid to do anything,'" he says. "If they don't want to come, they shouldn't come. I don't want a child slumped over, knowing this is an hour they will hate."

Not all parents are getting the message.

In a 2000 survey ordered by the American Obesity Association, just 5.6 percent of respondents said obesity was the greatest risk to their child's long-term health. Just 15.3 percent said they were "very concerned" about the weight of their children.

Mr. Jenkins sees more obese children locally than he used to, and he pins some of the blame on modern lifestyle choices.

"A lot of the kids in Georgetown have nannies and baby sitters who sit them in front of the TV," he says.

Add to that the incredible shrinking gym classes he says some schools offer just 20 minutes of physical education once or twice a week and one sees a recipe for sedentary children.

"They're taking astronomy classes at 8 years old, which is fine, but they're not taking gym classes," he says.

Parents, he says, are starting to bring their children to the gym with them.

"[The children] see their parents go to the gym, and all kids want to do what their parents do," he says.

Aaron Savage, a personal fitness trainer who runs youth programs at the Fairfax County YMCA in Reston, says children relish the results that come from their hard work, whether it is being able to run a few extra laps around the track or seeing their jean sizes shrink.

Mr. Savage has his hands full counteracting a culture that encourages inaction.

"These kids are growing up with the computers," he says. After school, instead of breaking out their skateboards or bicycles, they are playing video games, watching movies or downloading music from their computers, he says.

•••

It would be easy to lay part of the blame on fast food, the ultimate siren song for children's stomachs.

Kerry Stewart, associate professor of medicine in cardiology at the Johns Hopkins Bayview Medical Center, says fast-food restaurants aren't as culpable as some would suggest.

"There are probably more latchkey kids around than ever before," Mr. Stewart says. "They tend to watch TV and play computer games."

That said, indiscriminate diets fuel the rise in obesity.

Children should eat foods that are lower in fat, in portions that do not encourage gluttony, he says. They also should watch what they drink. A 12-ounce can of soda can have up to 175 calories, about a 10th of a child's daily caloric allotment.

Given the rising numbers of obese children, he says it is incumbent upon pediatricians to tell parents of the potential health problems their sons and daughters face.

That isn't being done enough, says Dr. Sarah Barlow, assistant professor of pediatrics at the St. Louis University School of Medicine.

Dr. Barlow recently polled doctors, dietitians and nurse practitioners to find out how they were screening potentially obese children and adolescents.

The findings told her significant barriers exist to prevent such screenings.

Among the problems doctors face when treating an overweight child are the attitude of the family, a lack of motivation and concern, existing health problems and a sense that the situation is futile.

Dr. Barlow says pediatricians hear it all from their patients' families.

"Some say, 'I'm big, my husband's big, my child's big. He's happy. I'm not worried about it,'" she says.

To counter that, doctors should present weight management as a health problem, drawing on a family's health history to pinpoint potential trouble spots such as heart disease and diabetes.

Doctors also can document a child's growth patterns using the BMI index to determine whether a child's weight has increased disproportionately to his or her age and height.

Tracking those figures and asking important lifestyle questions takes time, Dr. Barlow says. That's a luxury many pressure-filled offices don't encourage.

One reason some children weigh in as a bit heavier than others is because of their slow metabolisms.

Dr. Sergio Buzzini, a physician in the adolescent-medicine division of Children's Hospital of Pittsburgh, says that shouldn't be an excuse.

"The message there is, you cannot change your genes, but you can change your behavior," says Dr. Buzzini, who estimates about one in seven children is overweight. The changes mustn't be quick fixes, either, he says.

"You have to treat obesity as a chronic disease," he says.

Dr. Buzzini often tells young patients to write down everything they eat over a short period so he can discuss their diets with them.

Parents can help shape a child's diet by offering healthy choices.

Let the children choose which healthy snack they like, he says, rather than forcing one particular item upon them. Also, get the family together whenever possible to run, bike or even walk.

"The exercise doesn't have to be vigorous," he says.

Dr. Barlow predicts the upward trend in obese children will continue for the foreseeable future. She compares the media's work in informing the public of the problem to a doctor's efforts in telling parents about a concern for their corpulent child.

Recognizing the problem is the first step for both the public at large and the specific parent. Now, she says, "you have to make the changes."

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