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Worcester Telegram & Gazette

March 1, 2004

Too heavy too early
Helping overweight kids headed for heart disease

Author: Elizabeth Cooney

Section: HEALTH
Page: C1

The young man knew he was headed for trouble.

He'd never been heavy before sixth grade, but once he hit middle school the pounds started to pile on. Recess was no longer part of the school day, his friend down the street moved away, and gym once a week did little to put a dent in the calories he was consuming, from soda at school to dinners in front of the TV at home.

He would eat continuously, not even enjoying the food, while absorbed in the TV program he was watching.

''You need help. It's almost like a drug addiction,'' he said last week. He spoke on condition of anonymity at his home in a Worcester suburb where he lives with his parents and younger sister. ''I know that's a strong term, but that's what it is. If you keep going, you could end up at 700 pounds.''

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The eighth-grader weighed 200 pounds when his pediatrician sounded the alarm. The doctor preached adding exercise and choosing better food.

It sounds so easy -- eat less and exercise more -- but there is nothing simple about a problem that threatens the health of a growing number of Americans.

Too much food and too little exercise has led to an epidemic of obesity. A sedentary lifestyle combined with excessive consumption contributes to about 300,000 early deaths in the United States every year and costs more than $90 billion in health care, according to the Centers for Disease Control and Prevention. Obesity ranks right behind smoking as the leading preventable cause of death in America, according to a 2001 report by the U.S. Surgeon General.

The picture looks even bleaker for the next generation. When children and adolescents are overweight, they can stack the odds against a healthy adulthood. Sometimes they accelerate the onset of diseases associated with their elders so much that danger crops up before they leave their teenage years.

That's why they show up in the Pediatric Preventive Cardiology Program at UMass Memorial Medical Center -- University Campus. The aver age age is 13, but children as young as 9 are referred for help.

''We're increasingly deluged with requests for consultations on children who now have high blood pressure; they have high cholesterol, they're overweight,'' said Dr. Phyllis Pollack, director of the division of cardiology in the department of pediatrics at UMass Memorial. "They have all the diseases that the adults have related to risk factors for heart disease, but now we're seeing them 20, 30, 40 years early.''

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Pediatricians such as Dr. Richard C. Antonelli of Sterling, who is also an assistant professor of pediatrics at UMass Medical School, are referring more and more patients to the program. Twenty years ago the majority of children who needed a pediatric cardiology consult had congenital heart defects, Dr. Antonelli said.

Not anymore.

''The majority of my cardiac issues right now in children and adolescents have more to do with high blood pressure and obesity,'' he said. ''It'! s absolutely striking and it has exploded in the past two decades.''

Over that time span the prevalence of overweight children and adolescents has doubled, to 15.3 percent of 6- to 11-year-olds and 15.5 percent of 12- to 19-year-olds, according to the American Academy of Pediatrics.

''American children and adolescents today are less physically active as a group than were previous generations, and less active children are more likely to be overweight and to have higher blood pressure, insulin and cholesterol concentrations, and more abnormal lipid profiles,'' the AAP said in a policy statement published in the August issue of Pediatrics.

Experts agree that a complex combination of factors in society has led to overweight children, from super-sized restaurant portions to neighborhoods unsafe to play in or walk home to. Fast-food meals loaded with fats and sugars are marketed directly to children on television shows that keep them indoors. Computer games ! engage them for hours while their harried parents' own inactivity sets a bad example. Specialized sports programs favor superior achievement over general fitness, just as physical education gets crowded out of the school day.

''We have come as a society to accept obesity,'' said Dr. James H. Moller, professor of pediatrics at the University of Minnesota Medical School in Minneapolis. He spoke last month in Worcester as part of UMass Medical School's Viles visiting professorship. ''Cars have become rolling lunchrooms. Playgrounds have become PlayStations.''

The consequences are chilling.

''As a nation we are at risk of having a situation where our children have a shorter life expectancy than their parents,'' he said.

When children come to the preventive cardiology clinic, they complete a questionnaire that asks about medical problems in close family members. To be referred to the clinic, they already have two risk factors. The first would be weight and the second would be high blood pressure, high cholesterol, or bot! h. Another would be a smoker in the family or a parent with high cholesterol. A family member's sudden death before age 55 would also be an ominous indicator of future illness.

Children who have developed the kind of diabetes that in past decades was found only in adults -- and which Dr. Antonelli now diagnoses once a month -- are followed by a pediatric endocrinologist. An orthopedic specialist treats musculo-skeletal problems associated with overweight, which is defined as a body mass index at the 95th percentile or higher on CDC charts.

The clinic's questionnaire also quizzes the children on their lifestyle. Do they play sports, music, belong to clubs, eat breakfast? How much time do they spend watching TV, playing video games or using a computer?

Nancy M. Hagberg, a family nurse practitioner and director of the program, points out connections between ''screen time,'' whether it's sitting in front of the television or a computer monitor, and being ov! erweight.

''If they take their food and sit in front of a screen, often they don't have a cue of being full. They just munch constantly,'' she said.

Minimizing time in front of the tube helps in two ways, Dr. Pollack said.

''If you limit their screen time, you know what they do?'' she asked. ''They go outside and they run around. And they eat less because they are not sitting down.''

Sounds simple, but it works, she said.

''You know, it's not rocket science. You have to exercise more and eat right,'' she said.

At the clinic, which runs weekly in the Benedict Building at UMass Memorial Medical Center -- University Campus and at a UMass Memorial clinic at 881 South St., Fitchburg, the emphasis is not on losing weight but eating well.

''In children it's really not weight loss but weight management,'' Dr. Pollack said. ''As they continue to grow, in three years they could be in the normal range if they stay stable.''

Normal weight is quite an achievement for a child referred because of risk factors for heart disease. Other risk factors can revert to normal, too.

''That's the beauty of this,'' Dr. Pollack said. ''If you exercise and watch what you eat, a lot of times you can basically cure the hypertension and high cholesterol without using drugs. That's the goal for us. We don't want kids on chronic medication starting in childhood.''

Children who exercise can bring their blood pressure down even without losing weight, she said, but if they exercise and lose weight, their blood pressure gets even better.

One 12-year-old patient and her parents collectively lost 35 pounds over three months. Her systolic blood pressure -- the top number -- fell from 132, which is on the upper limits of normal, to a much healthier 120.

That success story shows how Ms. Hagberg enlists the whole family in the effort. To keep them all going, she introduces new suggestions for change at each of the monthly follow-up visits.

To help family members make better food choices, she uses an approach like Weight Watchers, emphasizing a varied diet with plenty of fruits and vegetables, dairy as a source of calcium, and whole grains. Treats are not forbidden, but they must be counted against the day's total intake.

At the first visit, she might urge the child to dump soda and fruit juices, which are both high in sugars. Eating at the dinner table is encouraged; surveys show vegetables are more often part of a meal at the table than on the couch. On another visit, she might ask the child to pick a favorite fruit to substitute every day for a less healthy snack. Enrolling in an exercise class or beginning to walk regularly would be another step.

The eighth-grader who compared being overweight to being addicted to drugs likes the gradual approach Ms. Hagberg has used in his three visits with her.

''She presents one thing at a time. You focus on individual goals, then combine them,'' he said.

For exercise, he does kung fu, skiing and weight training. His family joins him at ! the gym for the weight lifting.

''We've all become a little more active,'' his mother said.

Health risks such as heart disease may be scary, but the teenager has another motivation that keeps him on track.

''Girls, I guess,'' he said, when pressed. ''Kids who weigh 200 pounds are not going to get a girlfriend.''

Elizabeth Cooney can be reached at ecooney@telegram.com.

ART: PHOTOS; GRAPHS

PHOTOG: (1) T&G Photo/PAUL KAPTEYN (GRAPHS) JULISSA MORA/NYTRENG

CUTLINE: (1) Nancy M. Hagberg, director of the Pediatric Cardiology Prevention Program at UMass Memorial Health Care Inc., and Dr. Phyllis Pollack, director of Pediatric Cardiology. (GRAPHS) Is your child overweight?

Caption:
PHOTOS; GRAPHS (1) T&G Photo/PAUL KAPTEYN (GRAPHS) JULISSA MORA/NYTRENG
(1) Nancy M. Hagberg, director of the Pediatric Cardiology Prevention Program
at UMass Memorial Health Care Inc., and Dr. Phyllis Pollack, director of
Pediatric Cardiology. (GRAPHS) Is your child overweight?

Copyright (c) 2004 Worcester Telegram & Gazette Corp.
Record Number: 0403018579