Stopping Childhood Obesity

At the recent American Academy of Pediatrics' conference this past weekend, childhood obesity was a recurring theme. Obesity is primarily influenced by environment, something that parents have a fair amount of control over. What you feed your child, how active they are, whether you restrict screen time or not, and how much sleep they get all affect your child's weight. With one in three U.S. children now overweight or obese, though, clearly something has broken down.

In his session "Identifying and Treating Obesity Related Comorbidities," William J. Cochran, MD cited these jarring facts:

• Forty percent of children ages one to five years old have a television in their bedrooms, contributing to sendentary screen time
• About 20% of overweight and obese children get too many calories from sugary drinks such as soda
• Most parents and their children don't understand how big a portion of food is, making it hard for them to gauge their food intake
• If a child's parents are obese, that child has a 60% chance of becoming obese. If a child's parents are normal weight, that child has a 9% chance of becoming obese

The CDC states that our society is also "obesogenic," rife with unhealthy food choices and sedentary lifestyles. A family's lack of knowledge or tools to stop obesity just adds to the problem.

The question is what to do about obesity. Policy changes and initatives can help, such as Michelle Obama's "Let's Move" campaign to reinforce healthy behaviors in kids. There have been more extreme measures to stop obesity as well. Because obesity and its unhealthy extreme, morbid obesity, can cause a host of other health problems, such as Type II diabetes, sleep apnea, high blood pressure, and heart disease, on rare occasions parents of morbidly obese children or teens are charged with child neglect or abuse, as a single mother was in 2009 when her 14-year old son weighed 555 pounds. Most pediatricians are understandably reluctant to go down this path, since it would be best if the family could makes changes to help the child control or lose weight.

At the AAP conference, the Nestle Nutrition Institute and the AAP announced a new campaign to stop childhood obesity before it starts, by trying to instill good eating habits in children ages 0 to age 4. Their Healthy Living for Active Families (HALF) Project plans to distribute materials about healthy eating, serving sizes, and physical activity in pediatricians' offices, workplaces, and child care facilities.

Admittedly, Nestle is an odd partner, with its well-known candy brands and scandals over formula marketing in developing countries. Hopefully the AAP's voice will dominate the discussion, and get parents to take the threat of obesity seriously.

Parents and Infant Swim Lessons

A recent article in the San Francisco Chronicle on infant swimming shined a light on the psychology of parents in the Bay Area. The article discussed the American Academy of Pediatrics' official policy statement on infant swimming programs, in light of a local and nationwide boom in these programs. The AAP argues that children are not developmentally or cognitively ready to swim safely until they are four or older, and learning to swim earlier may give parents a false sense of security.

Despite these warnings, the popular and expensive La Petite Baleen program in the Bay Area, which often boasts a waitlist to get into classes, begins training children to be submerged in the water when they are just two months old. A new La Petite Baleen site is slated to open in June in the Presidio in San Francisco, and there are already 1,000 children enrolled, the article stated.

New parents are marketed to relentlessly. I still remember the box of formula that the postman shoved through my gate when I was pregnant with my first child (a product that I didn't want or need), and the mailings I received from Gerber and other companies who knew my due date, probably because my doctor's office had sold them the information. I heard a constant drumbeat of advice and buying information as a new parent, some of it from valid sources and some not.

I succumbed to the marketing as well, I think. Did I buy a Britax car seat and a Hanna Andersson jacket for my daughter because they were the best items on the market, or because being able to afford these things was a marker of my social class as a parent? I probably made these purchases for both reasons. Similarly, I think that the popularity of infant swim classes also has an element of status in it.

Are parents enrolling their young children in La Petite Baleen classes because they think that the AAP is wrong and swim lessons are good for infants and toddlers? Perhaps. Equally compelling, I think, is the social status that attending the school confers to the parents, which trumps anything the AAP says.

ABC, the AAP, and Autism

I've been thinking a lot about the American Academy of Pediatrics’ recent protests of the January 31 pilot episode of the ABC television show “Eli Stone.” In the lawyer drama, a mother receives a $5.2 million settlement after she charges that the mercury-laden preservative thimerosol that was used in a vaccine caused her child’s autism. Since many children are diagnosed with autism around the time that they receive a number of vaccinations, some people have linked these vaccinations with autism, especially the MMR (measles, mumps, and rubella) vaccination.

A small but influential 1998 study suggesting a link between thimerosol and autism was later retracted by its authors, and researchers have since found no link between vaccinations and autism. Furthermore, thimerosol was dropped as a preservative in standard vaccines in the U.S. in 2001.

Some parents still refuse vaccinations for their children, though, due to concerns about vaccine contents and the possibility of rare complications. Their choices have lead to regional, sometimes fatal outbreaks of measles and whooping cough (pertussis) among unvaccinated children. Right now, for example, there is a measles outbreak in San Diego, with ten unvaccinated children and infants infected and over fifty quarantined.

The AAP only fueled the vaccination debate, however, with an emotional press release in late January, calling the “Eli Stone” pilot “the height of reckless irresponsibility.” In the letter, AAP President Dr. Renee R. Jenkins says that “if parents watch this program and choose to deny their children immunizations, ABC will share in the responsibility for the suffering and deaths that occur as a result. The consequences of a decline in immunization rates could be devastating to the health of our nation’s children.” The AAP went on to authorize the early release of a February Pediatrics journal article showing that infants expel the type of mercury used in thimerosol over ten times faster than they expel the type of mercury often found in fish. Some researchers believe that if heavy metals such as mercury build up in the body, they might cause autism.

But what this debate really comes down to is parents’ fear of autism, a fear that is especially acute in the San Francisco Bay Area where I live. A CDC study released in 2007 that looked at autism spectrum disorders in selected regions of the country found an average rate of autism of about 1 in every 150 eight-year-old children. Earlier estimates had suggested autism was much less prevalent, as low as 1 in 500 children. The CDC pointed out that it’s unclear whether the autism rates are increasing over time, or whether it is simply being diagnosed and reported more accurately.

Still, no one knows what causes autism, and a quick glance at the numbers makes it look like an epidemic. When I had my first child, I, too, was told by well-meaning acquaintances that mercury-laden vaccinations might cause autism, one of a long list of things to panic about as a sleep-deprived new Mom. If I had my child vaccinated and she developed autism soon thereafter, would it be my fault if the light in her mind dimmed? Was I willing to take that chance?

By the time my children were born, though, thimerosol had been pulled from the vaccines, and pertussis was making an alarming comeback in San Francisco among unvaccinated infants and adults whose pertussis vaccinations had worn off. My children were vaccinated.

There is a frightening childhood illness for every generation, it seems. At one time it was polio, until Jonas Salk developed an effective vaccine for it in the 1950s. My great aunt had polio as a young woman (luckily she recovered fully). My mother, who grew up in the Bay Area, remembers driving by San Francisco’s Shriner’s Children’s Hospital on 19^th Avenue with her family, where many of the young polio patients were dependent on iron lung machines, wondering if that would happen to her. Today, the old Shriner’s Hospital is a retirement community next to a row of modern townhouses, and thanks to the vaccine polio is almost completely eradicated worldwide.