Generation X-tra Large
How excess weight threatens Canadian kids

Andrea Kenney

Fifteen-year-old Adryan Zorec of Mississauga, Ont., will talk about obesity with anyone who asks. A slim and active boy until age 10, his life took a dramatic turn when his parents separated. A devastated Adryan packed on 50 to 60 pounds of excess weight from emotional eating, much of it from indulging in his favourite snacks: chips and cola. By age 12, he weighed 170 pounds on a five-foot frame and found physical activity increasingly difficult. “I still liked sports, but I couldn’t always keep up with my friends. I felt slower, so I shied away from them.”

When his doctor diagnosed him with high blood pressure, Adryan was shocked. “I knew there was such a thing as blood pressure, but I didn’t know it could get too high in kids.” His mom, Stephanie, admitted she’d been in denial. “I knew there was something not normal about his health. Every time he played outside, he was beet red from simple activities like riding his bike. When the doctor said he had high blood pressure, I felt guilty because how could he have eaten all the wrong foods without my buying the stuff?”

At the time, the family was adjusting to the recent separation of Stephanie and her husband. “I was a single parent running around and trying to work. It was easier to grab burgers and fries or a bucket of chicken.”

The seeds of what was to become a dramatic change in lifestyle for the Zorecs were sown from Stephanie’s feeling responsible. “I felt scared because I didn’t have a big picture of why this was happening. But my guilt triggered a need to do something, and not just for Adryan, but for myself and my daughter, too.”

Their doctor referred them to a registered dietitian who informed Stephanie and Adryan about wholesome foods, proper portions and healthy food preparation. She taught them how to read labels (see “Hey Mabel! Read the Label,” p. 26) and how important physical activity is to maintaining a healthy weight. Until then, Stephanie had not fully realized how excess weight was harming her son’s physical and psychological health. But experts are increasingly acknowledging the short- and long-term adverse effects of child obesity.

“The whole reason medicine and, to some degree, society have embarked on the child-obesity bandwagon is because of its impact on health,” says Dr. Laurent Legault, a pediatric endocrinologist at the Montreal Children’s Hospital. Today, type 2 diabetes— which used to be a disease of middle age — has tripled in kids and now accounts for 5% to 10% of new pediatric cases of diabetes in Canada (most cases of diabetes in children are type 1, an autoimmune disease). “This has put pediatric obesity on the map as something that’s worthy of our attention and energy,” Legault says.

Psychological and social problems are also issues for heavier children. “Obese kids have poorer body images. They are more dissatisfied with their bodies and get more weight-based teasing,” explains Dr. Gary Goldfield, a psychologist and senior investigator for Mental Health Research at the Children’s Hospital of Eastern Ontario in Ottawa. The overweight tend to be bullied and excluded more for being different and therefore are less likely to master crucial social skills. “A vicious circle can result, going from initial weight gain to feeling depressed and leading to more eating and weight gain,” Goldfield says.

Stephanie agrees. “Because of being called Fat Albert, getting shoved around and feeling insecure with no self-confidence, Adryan didn’t like school. He lost enthusiasm and couldn’t concentrate. He was barely passing.”

With its complications during the growing years and its role in the development of adult conditions, child obesity has prompted the Canadian Paediatric Society (CPS) to call it a major determinant of health (see “Excess Pounds = Excess Risk,” p. 58). And because of its epidemic proportions, the CPS considers it a critical public-health issue.

How did this happen?

Health agencies worldwide point to complexes of factors that interact to create contemporary “obesogenic” environments. These variables discourage physical activity while encouraging the consumption of large portions of foods high in calories, fat and sugar — conditions that foster the storage of excess energy as fat.

The Canadian Medical Association (CMA) points to excess body weight as an endemic problem of modern life. Kids are living increasingly fast-paced lives in homes with a single parent or two working parents, a setting in which calorie-dense convenience foods have become the key to coping with dining dilemmas. Contemporary community sprawl means calorie-burning walking and cycling are often replaced by driving to get to and from school and leisure activities.

Rough-and-tumble outdoor play has been usurped by sedentary indoor time — on the computer, at the video-game console or in front of the TV, from which kids are bombarded with ads for tasty fattening foods and drinks. And today’s youngsters have money; they can buy their own junk food fixes from vending machines, school cafeterias and convenience stores. Kids are doing a good job of imitating the eating patterns of Canadian adults, who have increased their per-capita energy consumption by nearly 20% since the 1990s, from an average of 2,300 to 2,700 calories per day, according to the CMA.

Add to that school board cutbacks in phys ed and sports, and no wonder the advocacy group Active Healthy Kids Canada reports that fewer than 50% of our children meet the minimum daily physical activity requirements for basic healthy growth and development. To make matters worse, Legault points out, genetics combine with environment to boost obesity risk. “Some families have a 30% to 50% genetic risk of gaining weight because of an inherited metabolism that more readily stores extra calories as fat. The obesogenic environment of the past 20 or so years favours these people gaining weight more easily and quickly.” Adds Goldfield: “Changes to our physical and social environments can help make healthy choices easier. But at the same time, we’re responsible for our own choices.”

Stephanie took that message to heart by making a clean sweep. Gone were the pop, cookies, chips and ice cream. “My fridge is completely different now. I keep it stocked with nutritious items that are quick to make — no more deep frying otherwise healthy fish!”

She no longer slips treats into Adryan’s lunches to compensate for things that aren’t going well in his life. Readily available in the fridge are a jug of ice water, fruit and yogourt. She buys 1% milk and whole-grain crackers and bread. “It’s hard at first, but once you get into it, there’s no other way to eat,” she says.

For Adryan, the tipping point came when he learned he could end up on pills and needles like some of his relatives who have diabetes. “That’s one thing I didn’t want,” he says. When his initial efforts led to slow weight loss, Adryan picked up the pace. He decided to play a range of sports all summer and began to watch his diet. “I started drinking water and eating fruit — I really enjoy grapes. No big meals and no seconds and thirds. I lost a lot of weight doing that.”

Does he miss his comfort food? Not really. “Instead of chips, I eat plain Cheerios with milk. And when I crave something sweet, orange juice is my substitution for pop,” he says. His blood pressure has been normal for more than a year. Now 15, Adryan weighs 150 pounds. His net loss is only 20 pounds from his age-12 weight, but he’s seven inches taller. “It’s a useful strategy if heavy preteens can maintain their weight while growing into their adolescent body,” Goldfield says.

As for his self-image, Adryan says, “people are saying good things about me now, like, ‘Wow, you look taller and slimmer!’” Adds Stephanie proudly, “His energy and confidence are through the roof.”

The Zorec family’s success is proof that healthier weights can be achieved despite societal influences. Stephanie is proud that her son’s blood pressure and weight are now healthy and that he’s maintaining an 80% grade average in school. But looking back, she still feels a twinge of guilt. “I was responsible for my son’s health and there I was contributing to something that could potentially have killed him!” she says. “It’s about taking control of your and your children’s lives,” she says. And Stephanie implores other parents to do the same.

“Don’t forget to get the support you need,” she advises. “There’s such a big help network out there — family, friends, neighbours, co-workers, doctors, the Internet, libraries and health- food stores. If your child has a weight problem, ask for pointers and act on tips.”

Sad stats

Excess weight is prevalent in Canadian boys and girls of all ages, ethnicity and socio-economic status. According to a 2004 Statistics Canada survey, 26% of our children ages two to 17 are overweight and 8% of these qualify as obese. That’s a 70% increase over the 15% who were overweight in 1978–79.

Fat chances

The likelihood that hefty kids will progress to obesity is around 50%.  he chance that an obese child will become an obese adult is 25% at age two and 50% at age seven or eight. For obese teens, who have fewer years before adulthood to normalize their weight, the risk jumps to between 80% and 90%. The World Health Organization has named the risk factors for child and adult obesity — unhealthy diet and physical inactivity — as two of the three most important contributors, along with tobacco, for a global epidemic of chronic disease.

Excess Pounds = Excess Risk

How weight weighs you down

Ever had to schlep around all day carrying a 12-kilogram back pack? Stressful and tiring, right? Well, carrying extra body weight has all the same effects — and more. Too much weight puts harmful strain on the joints and respiratory system. It increases pressure on the abdomen, which in turn can raise the risk of gastroesophageal reflux disease (even in teens) and undermine bladder control. Extra pounds promote high blood pressure and stress the heart by forcing it to pump harder.

Not only that, but deep-seated belly fat releases chemicals that can damage the cardiovascular system and raise levels of harmful inflammatory proteins in the body.  And the more fat cells your body has, the more resistant it becomes to the energy-storing action of insulin, a condition known as insulin resistance, whichpredisposes people to high blood sugar levels and type 2 diabetes.

Being overweight makes people less likely to exercise and therefore more likely to have weaker bones. Seriously overweight people often dislike being examined by doctors and may be more likely to miss regular checkups and screening tests. Still think challenging the scales is OK? Check out our checklists of the possible adverse effects in children and adults of too much avoirdupois.

New findings

A 2007 study in the Journal of the American Board of Family Medicine found that adults with children ate about a teaspoon (4.9 grams) more fat per day than adults with no kids, showing that children influence adults’ eating habits.

Research on the biochemistry of obesity in kids suggests that high-calorie, low-fibre foods may create a hormonal imbalance called leptin resistance, which may make them eat more food and be less active.

A Swedish study showed that when schools in Stockholm introduced healthier lunches and banned sweets, buns and soft drinks, the proportion of overweight or obese six- to 10-year-olds dropped from 22% to 16% in four years. In schools that did not introduce food regulations the percentage of overweight students rose from 18 to 21.

15 ways to fight child obesity

1. Don’t be in denial. While 26% of Canadian children are overweight or obese, a recent CMA-Ipsos-Reid survey found that only 9% of parents identified their children as such.
2. Have your doctor monitor your youngster’s weight. “Before age five, kids should be losing their so-called baby fat,” says Montreal pediatric endocrinologist Dr. Laurent Legault. “The average child is at risk of gaining weight too rapidly around ages four to six and at the onset of puberty.”
3. Don’t assume kids will outgrow excess weight. Often a change in diet and activity levels will be necessary. If there’s a problem, consult a dietitian.
4. Model healthy behaviour. A 2003 Statistics Canada study reported that girls ages 12 to 19 were nearly six times (and boys in the same age group three times) as likely to be obese if they lived with an obese parent. “Today’s parents need to be better models and encourage all members of the family, not just those who are overweight, to make eating and activity changes,” says Ottawa psychologist Dr. Gary Goldfield. “A message to‘go out and play will not be well received by kids if the parent is watching TV and eating potato chips!”
5. Educate your family about healthy and non-healthy foods. Start with Canada’s Food Guide to Healthy Eating. Learn to read food labels and follow recommended serving sizes.
6. Eat meals together. Research has shown that at sit-down family meals kids are more likely to consume wholesome foods and have their food choices and serving sizes supervised by parents. A 2004 study reported that making family meals a priority protected adolescents against unhealthy weight-control behaviours.
7. Reduce portion sizes. Use smaller plates and bowls and serve each person her own plate rather than place food in large help-yourself bowls in the middle of the table. “Wait at least 20 minutes before giving a child a second helping to allow his brain and stomach time to recognize satiety cues,” adds Goldfield.
8. Self-monitor. “Log your family’s food intake, physical activity and time spent watching TV and playing video games for three days to identify the areas you need to work on,” says Goldfield. Then set one or two realistic goals for eating and activity changes and log them on a chart — say, cutting  TV time, increasing bike time or limiting snacks to veggies and fruits.
9. Cut back on fast foods. Limit your consumption of convenience and restaurant meals to once a month or once a week — whatever is achievable. 
10. Stock healthy choices. Get fatty, sugary junk foods out of the house and replace them with easily accessible prepared fruits, veggies and whole-grain snacks. “Go out of the home environment for unhealthy snacks,” advises Goldfield.
11. Do not allow eating while watching TV. “This distracts us from feeling a sense of fullness and we overeat,”  Goldfield says.
12. Limit screen time. Healthy Active Kids Canada reports that less than 20% of children meet the Canadian Paediatric Society;s guideline of no more than two hours a day in front of a screen. More than 50% are watching two to four hours of TV daily, and an additional 33% are spending two hours or more at their computers.
13. Get kids more active. Health Canada’s Physical Activity Guide recommends increasing your child’s daily physical activity by 30 minutes while decreasing sedentary activities by the same amount. Unstructured play and activity can motivate kids to get more exercise. Have children walk or ride their bikes to and from school — if the distance is reasonable and the route is safe — preferably with companions.
14. Don’t reward kids with food. This reinforces the emotional value of food. “Instead,” says Goldfield, “motivate with verbal praise, such as, ‘Great job watching less TV this week!’”
15. Make sure your child gets adequate sleep. Researchers at Northwestern University in Evanston, Ill., found that losing just one hour of sleep increased children’s chances of becoming overweight. It’s thought that sleep deprivation may leave kids too tired to be active or disrupt hormones that influence how soon they feel full and hence how much they eat.