A Call to Action
Today’s Dietitian
By Carol M. Meerschaert, RD, LDN
Vol. 6 No. 4 p. 32

One morning, I grabbed a cup of consciousness (or espresso roast coffee) and headed to the computer. In my e-mail inbox was one of those “words of wisdom” letters titled “People Over 35 Should Be Dead.” Being older than 35 myself, the heading quickly woke me from my morning stupor.

The e-mail read: “Those of us who were kids in the 1940s, 1950s, 1960s, or even maybe the early 1970s probably shouldn’t have survived. We ate cupcakes, bread and butter, and drank soda pop and Kool-Aid with sugar in it, but we were never overweight because we were always outside playing. We would leave home in the morning and play all day, as long as we were back when the street lights came on. We did not have PlayStations, Nintendo 64, X-Boxes—no video games at all—no 99 channels on cable, videotape movies, personal computers, or Internet chat rooms. We had friends! We went outside and found them.”

As a dietitian, parent, and lover of physical activity, this message struck home. We have struggled to find the answers to the complex issues of childhood overweight prevention and treatment, and there, suddenly, the answer seemed to be staring at me from my inbox.

You all know the statistics on overweight: Currently, 64% of the adult population—or 123 million people—is either overweight or obese. The rate has doubled in children and tripled in adolescents since 1980. Approximately 15% of children and teens are overweight. The problem of overweight/obesity in America costs $117 billion annually and accounts for at least 14% of deaths in the United States, or some 300,000 premature deaths each year. As professional nutritionists, you also know that weight control is the time-honored balance of caloric intake and expenditure. So how do we help overweight children deal with this problem? How do we help prevent other children from becoming overweight?

While everyone agrees that children should be encouraged to eat a healthful diet, weight-loss diets are not the answer. The National Institutes of Health-funded Growing Up Today Study examined a cohort of children who are offspring of the Nurses’ Health Study II participants. These children were followed for three years, and those who were on weight-loss diets gained more weight relative to predicted body weight than the nondieters. Binge eating was also associated with dieting to control weight.1 The authors concluded that for many adolescents, chronic dieting is not only ineffective, but it also may promote weight gain.

In an earlier study, Field and colleagues found that dieting among teens did not necessarily lead to lower caloric intake, nor was dieting restricted to girls who were overweight. Sadly, 50% of the girls who were below the national age-standardized 15th percentile for body mass index (BMI) reported their ideal weight as less than their current weight.2 Emphasis on thinness and dieting seems to backfire.

A prospective, three-year study of female students in grades 7 to 10 found that restrained eating, body dissatisfaction, drive for thinness, self-induced vomiting, laxative use, diet pill use, and alcohol use significantly increased, while attitudes about physical appearance and self-concept significantly decreased among frequent dieters compared with nondieters.3

What about the energy expenditure side of the energy balance equation? A group at Brigham and Women’s Hospital in Boston examined a nationwide cohort of 6,149 girls and 4,620 boys aged 9 to 14. They found that in both boys and girls, a one-year increase in BMI was larger in those who reported more time with TV and videos. Larger increases in BMI were also seen among girls who reported higher caloric intakes and less physical activity.4

Lisa Sutherland, PhD, RD, research assistant professor of nutrition at the University of North Carolina at Chapel Hill, studied national health data on adolescent obesity, calorie intake, and physical activity from 1980 to 2000. To determine overweight in children, she used National Health and Nutrition Examination Survey II and III and 1999 Centers for Disease Control and Prevention (CDC) data on BMI. Calorie intake was determined using the Nationwide Food Consumption Survey (NFCS) and the Continuing Survey of Food Intake by Individuals from the U.S. Department of Agriculture. Physical activity was determined by examining data from the Youth Risk Behavior Survey, CDC.5 The result was that in people aged 12 to 19, obesity rose 10% during that time frame; calorie intake rose a mere 1%; and physical activity fell a substantial 13%.

Could it be that a large decrease in physical activity, not changes in caloric intake, is responsible for increases in childhood obesity rates since 1980? Decreased physical activity has an impact on adolescent overweight. Sutherland concluded that both sides of the energy equation need to be addressed when creating community, state, and federal programs and policy that address childhood obesity.

A National Bureau of Economic Research paper by Lakdawalla and Philipson gives compelling evidence that technological change has induced weight gain by making people more sedentary.6 They argue that 60% of the weight gain seen in the U.S. population may be due to factors such as declining physical activity from technological changes. When was the last time your kids shoveled the driveway? Hung clothes on a clothesline? Chopped wood for the woodstove? Waxed the floor?

A National Association for Sport and Physical Education survey found that 81% of adults said they believe daily physical education should be mandatory in schools. Surprisingly, Illinois is the only state that requires daily physical education classes for students in grades kindergarten through 12. The California Education Code mandates physical education for all students in grades 1 through 9, but only one additional year in the four years of high school. In contrast, Colorado and South Dakota do not have any mandate for physical education at any grade level. The result is that grade school children are now 24% more active than high school students. Schools struggle to meet the demands of state education initiatives and federal initiatives such as “No Child Left Behind,” so physical education and recess get squeezed out of the school day.

When trying to solve the puzzle of increasing childhood overweight, ponder this: In my elementary school, we had recess three times per day. In my son’s school, they get one 15-minute recess after lunch. I walked to school; now my children take a bus. According to the CDC, 85% of children’s trips to school are by car or school bus, and only 13% are on foot or by bike. Does your community have bike racks and sidewalks? Crossing guards? Sutherland suggests that nutrition professionals get active in community programs, creating links with parents to increase opportunities for children to be active. She is currently a coinvestigator in the National Evaluation of the Walk to School Project. This critical evaluation seeks to understand how and why the program works and to identify parent and child barriers that prevent walking or biking to school. (To learn more, check out the CDC Kids Walk to School Program at www.cdc.gov/nccdphp/dnpa/kidswalk.)

American children do not walk as much as others. Susan D. Vincent, PhD, from Brigham Young University used pedometers to measure walking and showed that Americans walked less than their Swedish or Australian counterparts. Swedish boys, for instance, took as many as 18,346 steps per day, Australians took 15,023, and Americans took 13,872 steps.7

Often, tight budgets are the scapegoat for cutting physical education, sports, and other opportunities for kids to get active. However, a Harvard School of Public Health survey of 1,002 adults presented at their Spring Obesity conference found that 76% of adults would support measures such as offering more physical education classes and educating parents about healthful eating and exercise, even if it meant higher taxes. Further, 42% would pay $100 more per year in taxes to support these kinds of efforts.

Physically active children gain more than just weight control. A California Study matched scores from the spring 2001 administration of the Stanford Achievement Test, Ninth Edition (SAT-9), with results of the state-mandated physical fitness test, known as the Fitnessgram, given in 2001 to students in grades 5, 7, and 9. Reading and math scores were matched with fitness scores of 353,000 fifth-graders, 322,000 seventh-graders, and 279,000 ninth-graders. Higher achievement was associated with higher levels of fitness at each of the three grade levels measured. The relationship between academic achievement and fitness was greater in mathematics than in reading, particularly at higher fitness levels. Students who met minimum fitness levels in three or more physical fitness areas showed the greatest gains in academic achievement at all three grade levels.

How can nutrition professionals get more information to get more involved?
• Visit www.cdc.gov/mmwr to read a report on how your state measures up. The CDC, in the August 15, 2003, issue of MMWR, “New Physical Activity Measures include Lifestyle Activities, Behavioral Risk Factor Surveillance System 2001” provides baseline data nationally and for each state and U.S. territory based upon the measurements used for 2001.
• The California Department of Education (www.cde.ca.gov/cyfsbranch/lsp/health/pecommunications.htm) has recommendations on physical education for teachers, students, and their families.
• Check out www.presidentschallenge.
org, a new interactive Web site to help all Americans build a regular physical activity routine. This Web site tracks progress toward earning presidential awards for active lifestyle and physical fitness.
• Download or order materials from the VERB Campaign (www.cdc.gov/youthcampaign/materials/index.htm) to increase physical activity. The materials feature campaign materials for use with ’tween audiences, including posters, stickers, and temporary tattoos that organizations can order free of charge.
• The CDC also has free brochures to help increase physical activity among elementary and middle school-aged children. The parents’ brochure is available in English and Spanish versions at www.cdc.gov/healthyyouth/physicalactivity.
• Learn about the National School Fitness Foundation (www.cdc.gov/youthcampaign/materials/index.htm), a public, nonprofit organization, founded in March 2000 to fight childhood obesity and inactivity. Their Leadership in Fitness Training (LIFT) program offers aerobic and strength training equipment, computerized assessment kiosks, curriculum, and complete faculty training and certification to schools. As of September 2003, the LIFT Program was being utilized by students in more than 450 schools in 18 states (www.nsff.net).
• Use the tools found on www.kidnetic.com, a healthy eating and active living Web site designed for kids aged 9 to 12 and their families to inspire them to move toward healthier lifestyles. Kidnetic.com is also a resource for health professionals and educators to use when working with patients and students. Kidnetic.com is the initial program element of ACTIVATE, an educational outreach program of the International Food Information Council Foundation developed in partnership with the American Academy of Family Physicians, American College of Sports Medicine, American Dietetic Association, International Life Sciences Institute Center for Health Promotion, and National Recreation and Park Association.

— Carol M. Meerschaert, RD, LDN, is a freelance writer in Falmouth, Me.

References
1. Field AE, et al. Pediatrics. 2003;112(4):900-906.
2. Field, et al. J Am Acad Child Adolesc Psychiatry. 1993;32(6):1246-1252.
3. French SA. J Adolesc Health. 1995;16(6):438-447.
4. Berkey CS, et al. Pediatrics. 2000;105(4):E56.
5. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Youth Risk Behavior Surveillance System, 2001.
6. Lakdawalla D, Philipson T. The Growth of Obesity and Technological Change: A Theoretical and Empirical Examination NBER Working Paper No. w8946. May 2002.
7. Medicine and Science in Sports and Exercise. August 2003. Available at: http://www.ms-se.com

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