Supersized Kids
As American boys and girls pack on the pounds, weight control programs that stress parental involvement help youngsters shape up and eat right

By Heather Stringer
June 30, 2004

Shirley Luna, a public health nurse, could see the stress weighing on her stepson. He was struggling to cope with junior high, two new baby half siblings, and tension between his biological parents, and he’d found a simple way to ease his pain: eating.

He was not obese, but clearly was overweight. One day, the Mountain View, Calif., nurse mentioned the Stanford Pediatric Weight Control Program. Her stepson was resistant at first, but later agreed to go once a week with her to the four-month program.

Participants learned what foods were healthy and which ones to avoid, how to exercise, and how to set goals. But, most importantly, Luna and her stepson learned to be partners. He was not alone, and finally had an ally in fighting his battle.

That the obesity epidemic has spread to America’s children is common knowledge, but solutions to the problem are more elusive. Nurses have discovered that parents are often aware of the need for healthier habits in the household, but families find it difficult to change ingrained lifestyle patterns. Luna can vouch that it’s possible to wean children off of chips, pizza, and sodas, and the odds of success are highest when parents, siblings, and even school districts partner with youngsters to resist the temptation to eat empty calories and sit in front of the television.

The growing pediatric obesity problem started registering on the radar about two years ago when the National Health and Nutrition Examination Survey found that an estimated 15% of children aged 6 to 11 were overweight — about double the number from 20 years ago and almost triple the number from 30 years ago. The increase among 12- to 19-year-olds in the last 20 years was even more dramatic, with a jump from 5% to 15%. (Overweight was defined as children in the 95th percentile or greater for their body mass index.)

Green light, go!

For Luna, PHN, the fruits of her stepson’s decision to seek help were obvious as early as the initial drive to the program. “The time in the car gave us time to talk,” Luna said. “He shared what was going on in school, what he liked and didn’t like.” At home, he’d been quiet and reserved, but when given time alone with his stepmother, he started talking openly.

Early in the Stanford program, the leaders explained to parents and children that they were a team. Both were asked to complete food logs and check in with one another daily about foods they were eating. They learned a system in which “green lights” were labeled healthy foods, such as vegetables and fruit, and yellows were cautions, such as spaghetti, breads, and cereal, and reds were empty nutrition, such as chips and dessert. They were allowed to eat reds, but just limit the amount, Luna said.

As she and her stepson started their daily check-ins, Luna learned he was eating most of his junk food outside the home — at school or other homes. Both would set goals for how much they planned to increase greens and yellows, and reduce reds. They also set goals for exercise each week. If they met their goals, they earned a preplanned prize.

“I would make his bed or wash dishes for him,” Luna said, “and if I met my goal, he would do something for me.”

Although her own cooking was somewhat healthy, Luna learned how to be even wiser about shopping and cooking. Instead of serving hot dogs, she started cooking chicken sausages. Now, she makes spaghetti with zucchini, onions, and red peppers instead of sausage.

Partnership between the parent and child is also a tenet of the Shapedown program, which was founded more than two decades ago at the University of California, San Francisco. Linda Lenoir, RN, MSN, a school nurse in Palo Alto, Calif., decided to become a Shapedown instructor when she started noticing that more and more children were overweight when she did scoliosis screenings.

Healthy households

“In the Shapedown program, it’s not the child who is identified as the ‘patient,’ but rather the family dynamics,” Lenoir said.

During the 10-week program, parents and children learn how to read food labels, remove junk food from the house, eat at holiday times, and limit computer and television time to encourage more exercise. Parents also are expected to facilitate daily family times at home when each member of the family praises and acknowledges one another.

Lenoir has taught the courses for about seven years through the Palo Alto Medical Foundation and the San Mateo County Health Services Agency. Each time, she looks forward to the changes she witnesses in families.

“At the end of the sessions, it is so satisfying to see children feel better about themselves, and feel empowered about how to choose what to eat and how to talk to people when they are teased,” she said.

In some cities like Los Angeles, entire school districts are taking on the problem of childhood obesity. The L.A. Unified School District has gone as far as to ban certain foods like sugar-sweetened soda on campus and the sale of junk food, said Karen Maiorca, RN, M.Ed., a school nurse in the district. School administrators also are joining forces with groups like the American Heart Association to plan ways to tackle the problem, and the district is offering activities that allow entire families to get physical exercise.

Although parental and school district involvement is valuable, not all children have that luxury when it comes to their problems with weight.

Tess Callinicos, RN, MSN, CPNP, a school nurse at Garden Place Academy in Denver, started a walking club during lunch to help students maintain their weight. She doesn’t expect the children to lose weight, but hopes they will thin out during their growth spurts if they can simply avoid weight gain before those spurts.

Each year, she works with a different grade level, and this year she’s walking with the first- and second-graders. This year’s participants were the first to receive pedometers to track how many steps they were taking (they averaged about 2,000 during the 25-minute walk). The pedometers have proved to be a major incentive to motivate the students to walk faster and farther.

Callinicos also has learned firsthand how important it is for parents to be part of the solution to a child’s weight problem.

Garden Place Academy is in an area with a high Hispanic population, and one of the kindergarteners Callinicos walked with last year weighed 94 pounds when he started her lunch exercise program. The walks helped him maintain his weight all year. But after three months of summer, he weighed 138 pounds. His asthma and sleep apnea make him a prime target for weight gain, but Callinicos knew his family’s eating habits were one reason he was packing on the pounds.

“When I approached the mom, she said, ‘I’m not going to starve my child,’ ” Callinicos said. She would like to invite people like this to a parent education group she plans to start in the fall.

Catch ’em young

Even though Callinicos is working with students as young as kindergarten, Elizabeth Reifsnider, APRN, PhD, believes the obesity problem can be traced back to habits set as babies and toddlers. An associate professor at the University of Texas Health Science Center at San Antonio, Reifsnider decided to research obesity among children aged 2 to 4.

“I’d like to prevent children from becoming obese because once they are overweight, it’s harder to lose weight than if they don’t start off heavy,” she said. “The older someone is, the harder it is to lose weight.”

With grant money from the National Institutes of Health and the Texas Department of Health, she started studying toddlers who had a BMI in the 95th percentile or higher. She discovered that many of the children had cavities along with being obese. Based on surveys from the mothers, she believes many of these children had sweetened beverages in their bottles, such as soda. These toddlers would carry their bottles throughout the day and sip on high-calorie drinks.

Reifsnider also discovered that the more hours the toddlers watched television, the heavier they were.

“I also found that the longer mothers breastfed, the less likely their children were to be obese,” she said. She attributes this to the fact that a nursing baby fills up and then doesn’t eat again until the next meal, while a baby who has a bottle can snack throughout the day.

Mothers who were strongly directive about feeding also tended to have heavier children. Rules like “You must clean your plate” or “You can’t eat dessert until you eat your vegetables” taught the children to ignore their own sensations of fullness, Reifsnider said.

Although all of these parenting behaviors influenced the likelihood of childhood obesity, the heaviest association was when parents were obese. “Some of it may be genetics, but it could also be the way a family cooks,” Reifsnider said. “I’m seeing it as a family issue, and the whole family has to change their activity level and cooking habits.”

She encourages families to try simple changes first, such as switching to low-fat milk and diet drinks, and consuming more water instead of sweetened beverages. She also advises families to limit fast-food trips to perhaps once a week.

For some families, changes like this may seem monumental when juggling the stresses of working and parenting, but Luna has seen the payoffs of making these adjustments.

During the Stanford program, she lost more than 10 pounds and her stepson, who was 12 at the time, also lost weight. Now, he’s a 19-year-old college student who exercises regularly and makes informed choices about what he puts into his mouth, Luna said. She also shares his joy when he expresses the high he feels when finishing first during a running exercise in his health-conditioning class.

Five years after her stepson finished the class, Luna volunteered to be a facilitator for the program. She understands what many parents may feel, and how important it is for them to guard their alliance with their children, even when the barriers seem insurmountable.

“Our society is so thin-conscious that you can almost be prejudiced against overweight children,” she said. “It’s important to realize where you are starting from, and all of the emotional issues that affect how we eat. I tell them to take it step by step, and sometimes it will be a faster journey, sometimes slower.”

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