Across the nation, obesity has become an epidemic among adults and children alike. In Rhode Island, a recent national report showed, 21.7 percent of adults are obese – the fourth-lowest rate in the country – but 30.1 percent of children ages 10 to 17 are obese or overweight, worse than in 20 other states.
As part of an effort to combat childhood obesity, Memorial Hospital of Rhode Island has started a new program called Youth Fit, funded in part by a $40,000 grant from Blue Cross & Blue Shield of Rhode Island, to help families improve their children’s fitness and health.
Dr. Marjorie Nasin, director of Memorial’s Pediatric Primary Care Center and a board-certified pediatrician with a focus on childhood fitness and weight management, answered questions about the program and about the obesity epidemic.
PBN: How serious an issue is childhood obesity, and is it getting worse?
NASIN: The rates of childhood overweight and obesity in America are increasing. Somewhere between a quarter to a third of children are at least overweight; upwards of 15 percent fit the medical definition of obese. These are certainly higher numbers than even a few decades ago, and there has been a simultaneous adjusting of the lay person’s perception of childhood weight. Many parents whose children are overweight are sincerely surprised when I suggest the child is carrying a bit too much weight. Our view of the “typical kid” has become a bit heavier as we become used to seeing so many overweight kids.
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PBN: You work with the Pawtucket public schools as well; do you see obesity as a major problem among students, and do you see demographic differences?
NASIN: While the increase in child weight has emerged across the economic spectrum, it is true that the poorer and the Hispanic communities have seen a disproportionate rise in obesity. Take-out food has been marketed as more affordable for those on a tight budget, and people have literally bought into that belief. At the same time, it has become culturally acceptable across the economic classes to use fast food as a regular part of the family’s diet. Some studies have estimated that 75 percent of adolescents eat something from a fast-food establishment on a daily basis. In terms of the race/ethnic variance, some of this is certainly genetic predisposition, but there are cultural and economic variables that exacerbate the genetic differences.
PBN: Is the problem poor nutrition, lack of exercise or both, and what role do you see for families in addressing the situation?
NASIN: It’s probably everything, and we don’t know exactly what factors contribute what proportion to the problem. Our society has changed so much in the past 30 years that studying all these changes has prompted more questions that it has answered! Certainly eating habits have changed: high-calorie drinks, increase in processed and low-nutrient foods, larger portion sizes for very young children. But the quality of leisure time has changed too: more sedentary activities, fewer opportunities for unstructured play, parental need to keep a “short leash” on children due to safety concerns, automated everything, more busing and less walking, and the list goes on. We are also finding many specific genes that play a role in how sensitive certain individuals are to these nutrition and activity changes, and many hormonal modulators that effect how we respond to our environment.
PBN: What will Youth Fit do, and how will you reach participants?
NASIN: YouthFit is a medically supervised lifestyle modification program intended to help kids ages 6 to 16 and their families make healthy changes. It is a weight management program in the sense that the modules and assignments will help children achieve a more healthy weight in the long run. Families receive incentives and kids get to experiment with different exercise/play equipment over the six-month period. The Boys and Girls Club of Pawtucket is my partner in providing more opportunities for active leisure time and a great social network for the kids. Interested families can self-refer by calling our office at (401) 729-2582, or they can be referred by their doctors.
PBN: How good is the science in terms of determining “best practices” to help children be more fit?
NASIN: There is fairly strong consensus in the medical and nutrition fields about the best nutritional approaches to obesity. There are fewer standardized approaches to the fitness aspect of childhood health, and there is room here for more research. The medical programs that attempt to help struggling families have two major challenges: finding a method that produces permanent improvement in health status (as opposed to just an initial drop in weight), and actually getting paid for the time invested in this endeavor. Which one needs to come first to “produce” the other is a subject of great debate right now. Meanwhile, however, we continue to raise a less healthy generation of children who are relying on us to recognize that this is the next big chronic disease of childhood.
