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Young Lives at Risk: Our Overweight Children

Susan Levine and Rob Stein
Washington Post Staff Writers
Monday, May 19, 2008 2:30 PM

Post staff writers Susan Levine and Rob Stein will be online Monday, May 19 at 2:30 p.m. ET to take your questions and comments about The Washington Post's examination of childhood obesity.

A transcript follows.

About this series: We are all responsible for the childhood obesity epidemic: parents, government, schools, communities, companies, the health system. This five-day series searches for solutions.

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Susan Levine and Rob Stein: Hello, everybody. Thank you so much for joining us to talk about this critical health issue. We're Rob Stein, of the national desk, and Susan Levine, of the metro desk, and we're ready for questions and discussion.

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New York, NY: Hello from Dr. Gina Villani, VP of Health at the National Urban League. Thanks for the series, I anxiously await the rest, but am concerned that the issue of obesity must be addressed in the context of the socioeconomic and cultural environments that these children are living in. If you have no hope of either being alive (due to the high rates of violence) or remaining unincarcerated by the age of 20, why would you care about what you are eating and the long term effects it may have on your body? I would love to share with you a study we did on the environmental contributors to childhood obesity in Ward 8, a thoroughly neglected community right in your own back door.

Susan Levine and Rob Stein: You're right, the socioeconomic factors involved in obesity are significant. The rest of the series this week looks at the problem in the context of schools, community (urban -- especially Ward 8 in the District -- and suburban) and the medical profession. As today's story did note, everyone has to be working together on this.

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Yonkers, NY: There is a lot of attention given to vending machines, but no one questions the constant barrage of sugary snacks and treats in the classrooms. My kids are in elementary school - it seems like cupcakes come in for birthdays at least twice a month, and then there are class parties as well, always featuring baked goodies like cupcakes, muffins, or cookies. That means my kids are taking time out from learning approximately once a week to eat sugarladen goodies. It really annoys me. We didn't have class parties with food back when I was in school (late 60's). What changed?

Susan Levine and Rob Stein: Take a look, please, at today's KidsPost story. It's about classes where sweets like cupcakes now are banned. A sad situation, yes, but one responding to these obesity numbers. In some schools, items like Lunchables also are prohibited for health reasons.

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Washington, DC: The Sunday segment of your series made me want to beat my head against the wall. I have been fat since I was 9 years old (back in 1968), and people always figured I would "grow out of it" back then. My blue-collar parents were so thrilled that I liked to read and wanted to go to college someday that they didn't force me to play outside like the other kids. Fast-forward to today and I still have a boatload of abdominal fat, and recent research says that I can never decrease the number of fat cells in my body no matter what I do, and I haven't even yet gotten to menopause, which seems to add a pad of fat to every older woman's stomach no matter how thin she is. Bottom-line question: what can I do to avoid total doom?

Susan Levine and Rob Stein: Rob here... There is a lot you can do. Obviously the best thing would be to try to get down to a healthy weight. But we all know how hard that can be. There is, however, increasing research that overweight people can reduce their risks by exercising more and improving their cardiovascular health. And you don't have to go crazy -- just getting a moderate amount of exercise -- like walking -- can make a big difference.

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Washington, D.C.: On my walk to work, I often see young children eating junk food for breakfast, and I just learned from today's Post that there are schools without PE teachers; all of this breaks my heart. What can I do about it - are there local organizations addressing these problems that accept volunteer time and/or money?

Susan Levine and Rob Stein: Susan here ... I'd first start with the school in your own neighborhood. Staff there might be thrilled to have community help on after-school (or even in school) activities geared at getting kids moving. As a story later in the week will show, P.E./recess doesn't require fancy gyms or equipment to be effective. Beyond schools, call your local Y, or Boys and Girls Club. Find a scout troop where you might be able to assist. Especially if you have certain expertise in a sport!

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McPherson Square: It appears that the best source of help for obese children comes from their parents. However, some of the parents are obese themselves. If weight is a concern for everyone in the family and there are no role models, what hope do these kids have of ever getting healthy? Is it the school's responsibility to step in?

Susan Levine and Rob Stein: Rob and Susan here ... You've raised a critical point, and it's why this issue is greater than parental responsibility. Parents do play a major role, obviously, setting an example and providing healthy choices. But some need educating themselves, having grown up in cultures or communities with little food or exercise options. There are neighborhoods with virtually no fresh fruits or vegetables, with few safe places to play, walk or exercise. And changes over the last 30 years in our "build environment" -- how communities are designed, how dependent we are on cars, etc -- have exacerbated the problem.

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Sioux Falls, S.D.: I am submitting this early because while you're online today, I'm joining a team of professionals to ask our state's Board of Education to pursue policy changes to strengthen health education and physical education in our schools. Our state's largest school district recently CUT the high school graduation requirements related to health education and physical education by two-thirds, citing the need for more "flexibility" for students to take advanced classes and still have time for electives. How can schools balance the need for higher academic requirements with the imperative need for health and physical education throughout a student's high school career?

Susan Levine and Rob Stein: Susan here ... The No Child Left Behind Act has been a frequent target on this point. Educators have cut time for subjects such as PE and recess because of their concern for time spent on tested areas like math and reading. Some critics feel that if NCLB included a physical activity standard, the pendulum might start swinging back. Beyond that, there have been a number of interesting studies about how children learn better when they're regularly given a chance to blow off steam and energy during the day.

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Baltimore, Md.: I work in an Annapolis public school that has free breakfast for all students. Honey Buns (30g fat), Pop-Tarts, and strawberry milk are the choices. There is cereal, but no kid takes it. They qualify as nutritious enough because the manufacturers enrich the products with vitamins. But ... BLECH. What is standing in the way of limiting breakfast choices, given the captive hungry audience, to less junky options?

Susan Levine and Rob Stein: Susan here ... Sen. Tom Harkin would love to hear from you! He's been trying for a dozen years to improve the nutrition standards for school breakfasts and lunches. His effort failed again this year. Interestingly, other countries have cracked down on this much more. Mexico, as today's story noted, is cutting whole milk and flavored, sweetened milk from its schools, as well as sodas.

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Washington, D.C.: Hi Rob and Susan,

How big a factor is genetics? I read somewhere that people of Asian extraction often experience type II diabetes at a lower weight than Caucasians because their genetics are such that the "starvation" mode kicks in faster.

Thanks!

Susan Levine and Rob Stein: Rob here... Yes, genetics clearly does play a role in both a person's risk for becoming obese and the effects of obesity on their health. But, as Susan just said: "Genetics is hardly destiny on this." Some of us clearly have to work harder than others. The key is trying to avoid weight gain initially. Since losing it is so difficult. But if you have already put on the pounds, working hard to stay as fit as you can does really help reduce the risks associated with being overweight.

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Ex Brussels, Belgium, now Maryland: When we returned from Belgium, we all gained significant amounts of weight (parents, 10 and 12 year olds). In Belgium, we all had chocolate frequently, the kids had soft drinks more than I'd like (the school had them in the cafeteria), but even with their wonderful cafeteria choices (I still follow the menu listings of their school in the online newsletter), they didn't like much beyond ham and cheese baguettes and French fries. Part of the problem there: too little time for lunch after waiting through the lines to get food.

So, from my perspective, weight problems caused in our case by too large portions, too much HFCS, too little exercise (the kids had 2 breaks besides midday and plenty of play equipment available at school).

Susan Levine and Rob Stein: Susan and Rob here ... The portion sizes in this country are stunning, ditto the ready access to snacks. In Europe, food seems to be confined more to mealtime than in-between time, and of course, people walk SO MUCH more than in the U.S. Having written that, tho, most European countries also have been fighting increased obesity rates among their children. They've reacted with much broader measures, and several (France, Switzerland) very recently reported the first numbers suggesting the trend line is reversing.

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Southern Maryland: Having adult family members who have diabetes, my heart breaks and shatters when I heard that children are being diagnosed with type II diabetes. Knowing the long term effects on ADULTS twenty and thirty years later with diabetes, I shudder to think of the health care crisis the US faces with today's type II diabetic 15 years old turning 35 and being diabetic for twenty years.

Susan Levine and Rob Stein: Rob here. You're absolutely right. The big increase in type 2 diabetes among children is one of the most worrisome aspects of the obesity epidemic. This is a disease that used to be called "adult-onset" diabetes because it was virtually unknown among children. That's no longer the case. As Robert Lustig of the University of California, San Francisco, said: "Once you get type 2 diabetes, figure you have 20 more years of life and then you are dead. So if you get it at 15 you'll be dead at 35." Chilling...

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Yonkers, NY: You referred to a story about a school banning cupcakes...When I suggested limiting the number of class parties that we brought goodies to (I was a class parent at the time), the other parents were outraged. I heard "Kids need to have their childhood" and "Its just a treat, it won't hurt them" and "This is how my child knows I love her" (in reference to sending in birthday cupcakes). I guess we weren't loved back in the '60s when this wasn't a custom yet. Anyway, I don't think bans like this will get traction until parents are educated as to the ramifications of "this one little treat."

Susan Levine and Rob Stein: Susan here: Sometimes parents are the biggest hurdle, yes. Perhaps with more awareness of how many children are overweight, and the health (and financial) burden that will follow, parents as a group will come around? Certainly, previewing a school story Wednesday, nutrition folks in the schools hope for a change in attitude.

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Cheverly, MD: I'm a 25 year old female middle school teacher in PG Co. and, believe it or not, I get teased (or receive unkind comments) because I am too thin! I actually am sort of "scrawny," as they say, but then I like it that way. And, because I'm reasonably popular, some thin students have told me they like that I make it "OK to be thin." How sad is that?

Susan Levine and Rob Stein: Susan here...There's another side of weight and eating, especially with girls, and it is just as tragic. I'm talking stick figures, anorexia and bulimia. Why can't we develop healthier body images all around?

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Columbia, MD: I teach in a Howard Co. middle school and have had some success in working with overweight students, mostly girls, to help them lose weight. If there's anything "positive" (probably the wrong term, but I can't think of another) about being extremely heavy, it's that the weight comes off pretty quickly to start, which can provide the incentive needed to keep at it. Some students lose 12-15 lbs. the first week, and their clothes feel loose after only 2-3 weeks. They do need a lot of hand-holding and other support, and it's hard if their families are not on board, but we have proven it can be done.

Susan Levine and Rob Stein: Rob and Susan here: That is a crucial point. It seems clear that families play a pivotal role. But families can only do so much. Kids are influenced by other kids, by the ads they see on TV, by all the food that's around them. A lot has to change to tackle this problem. But it does seem like enough parts of society are finally starting to pay attention.

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Reston, Va.: Yesterday, the Post quoted a doctor as saying that diabetics dies within 20 years of diagnosis. I don't remember the exact quote, but he said that someone diagnosed with diabetes at 15 years of age will be dead by 35. About 10 years ago I was diagnosed with Type II diabetes. We caught the disease in the very early statges and I have been on a strict diet and exercise plan ever since. I also take a long list of medications. I see my endocrinologist every three months. My blood test results have consistently been excellent with my A1C coming in between 5.0 and 6.0. While I carry about 25 pounds too many (I'm working on it!), there is no damage to my body or internal organs. Is diabetes going to kill me in 10 years? When I read your piece (about the effects of obesity on the pancreas) it made it sound like I would be dead within 10 years.

Susan Levine and Rob Stein: Rob here. Everyone is different, and diabetics who work hard and succeed in controlling their blood sugar can live long, healthy lives. As you know, it's a constant struggle, and many diabetics find it impossible to keep their disease in check. And not everyone has the same access to good health care, which is critical in chronic diseases like diabetes.

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Richmond,Virginia: As a teenager, I found P.E. to be a waste of time. Those who were fit excelled and those who weren't suffered through it. By that age, you are either participating in sports, exercising regularly, or really not that interested. I agree that schools should spend more times on academics and less time on what are essentially family or parenting issues.

Susan Levine and Rob Stein: Susan here ... Good point. The question is (having seen examples of worthless PE myself) how the time should perhaps be reinvented. What if PE at all levels was far more a combination of sports, health, exercise, movement, activity? Team-related sports always has divided students into the talented and "others." That has to change. The reality is, some children only see exercise as useful because of what they're exposed to in school. If they get it at an early age, they may be hooked for life (in the best way).

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Ellicott City, Md.: After reading about Jayonni, and seeing the photos of her with her mother, it seems clear to me that BOTH of them need to be educated about health and nutrition. Is there a program available to teach parents about basic nutrition and cooking? Is there a summer program available to bolster healthy eating habits for children? My heart goes out to Jayonni and children like her.

Susan Levine and Rob Stein: Please check with any community health program in your area, or call your local hospital. Many community clinics in the Washington region are sponsoring programs of this kind.

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Maryland: Does Dr. Villani really believe that a 10-year-old girl like the one featured in today's Post is morbidly obese because she fears violence or incarcertation? How about poor dietary habits that are passed down from generation to generation -- i.e. fried food, high caloric processed food, etc? You find the same problem, even worse, in West Virginia. Are West Virginians frightened into eating by violence and fear of jail?

Susan Levine and Rob Stein: There are lots of different factors that are contributing to the obesity epidemic. In urban areas, lack of access to fresh fruits and vegetables, and unsafe neighborhoods that make exercise dangerous, play a role. In suburban and rural areas the mix is different. In those places, reliance on our cars make us heavier. And overlaid on all these environmental influences are varying cultural perspectives about food and family gatherings etc.

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Arlington, Va.: I know that I am submitting late, but I hope you can take my question. I am a new mom, and as a child I was overweight and had bad eating habits. After suffering from an eating disorder for about five years, I am now a healthy weight. I am very concerned about raising my child with good eating habits and not passing on my own food issues. Do you have any words of advice?

Susan Levine and Rob Stein: Susan here (a mother of two girls) ... It's a difficult and ever-present concern. Show by example of what you eat and the activity and exercise you get. Do it together and make a point (but not too big a point depending on your child's age) of emphasizing health. And when your child gets to middle school, be ever more vigilant without acting like the food police. Best luck!

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Washington DC: What is the legal objection to providing healthier foods in schools? You said Sen. Harkin's efforts failed again this year. What was the nature of his attack on the problem, and what were the prevailing opponents saying?

Susan Levine and Rob Stein: Susan and Rob here ... This year, interestingly, all the stars seemed to be aligned. All parties were on board -- educators, food industry, health groups, etc. And still the provisions did not pass. But procedural wrangling pushed this aside. Only Congress can answer to that.

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Falls Church, Va.: If sufficiently vigorous, exercise can improve muscle tone and general heart/lung health. Obviously it's a good thing to do.

But it's hugely misleading to suggest that exercise can play a significant role in reducing obesity. At best, an hour of vigorous exercise might burn 500 calories. Children's recess is more likely to be 200-300 per hour. For overweight kids who are consuming 3000 calories per day, the effect of exercise upon their weight is always going to be minimal.

Susan Levine and Rob Stein: Rob here... Yes, you're right. It does take a lot of exercise to burn a lot of calories and offset the effects of overeating. But every little bit of exercise does help, and it's amazing how it can add up. And building exercise into your day tends to have a spillover effect -- diminishing appetite and often prompting people to make healthier choices about what they do eat.

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Susan Levine and Rob Stein: Thanks to everyone for all your great questions and concerns. There is so much more to be done. Hope you enjoy the rest of the series. I'm sure we'll be revisiting this issue a lot more in the future.

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