Fighting Childhood Obesityobese children, and, many times, parents don't know how to

help or change the situation.These children are often caught in a vicious cycle, notes

Cristina Fernandez, M.D., pediatrician and medical directorof the HEROES program. "They are bullied and made fun of,which lowers their self-esteem and makes them depressed,"she says. "This then feeds into their eating and weight prob-lem. One of our teenage girls told us her classmates werethrowing food at her like they were feeding an elephant.

OVING, AFFECTIONATE, INTELLIGENT, AND a bookworm that'show parents described their young teenage daughter. Weighing morethan 200 pounds, she often hid behind her books because it helped____ her feel invisible, a feeling she preferred to the teasing she endured

for her acne and weight.When she first came to the Healthy Eating with Resources, Options, and

Everyday Strategies (HEROES) program at Children's Hospital & MedicalCenter, staff saw a shy, withdrawn, and sad young lady who stayed mostly inthe background. Slowly but surely, however, she began to emerge as a leaderin the group. She lost more than 30 pounds and started to incorporate fitnessinto her daily life. She soon discovered a love for running. After completingsix months with the program, this young lady had become an intricate partof the group. She talked about the newness of having boys notice her — some-thing that had never happened before — and she gradually began to regain herself-esteem.

The staff at HEROES says scenarios like this are quite common among

'We can turn their lives around. These children need toknow they can change, they can do better, and they can doit every day. We teach them how. The quality of life for thesechildren improves significantly once they have been in ourprogram for a while."

Obesity is a growing problem in this country. The AmericanAcademy of Pediatrics reports that 20 percent of children »

Cristina Fernandez, M.D., pediatrician andmedical director of HEROES

« in this country are overweight or obese. Theproblem may be even worse in the Omahametropolitan area. A 2012 survey conductedby Children's Hospital and Boys Town Na-tional Research Hospital found that 30 per-cent of children aged 5 to 17 years old were

overweight or obese.

Obesity is a multi-factorial disease, saysFernandez. While genetics may play a role,the majority of children are overweight dueto their environment and an unhealthy life-style. Lack of exercise, extra-large portion siz-es, excessive snacking, and overconsumptionof fast foods, as well as excessive time spentin front of computers and video games, areall taking a toll.

Minorities like Latinos and African-Amer-icans have a higher rate of obesity than theCaucasian population, and this appears tobe in large part due to their environment,notes Fernandez.

But obesity is about more than be-ing overweight. It is a chronic diseaseand serious health problem that canlead to numerous health conditions,including type 2 diabetes, coronaryartery disease, high blood pressure,high cholesterol, sleep apnea, chron-ic headaches, venous stasis disease,urinary incontinence, liver disease,and cancer.

If the situation is not turnedaround, these children will begin

having the types of health problems in their20s and 30s that we normally see in peoplein their 60s and ,70s, explains Fernandez.

Losing weight and maintaining an idealbody weight often requires a multi-facetedapproach that includes medical manage-ment, nutrition counseling and education,exercise, behavior modification, and behav-ior therapy.

"Our goal is to help them work throughtheir barriers," says Martha Nepper, MS,RD, LMNT, certified diabetes educator andcertified childhood and adolescent weight

Obesity is a multi-factorialdisease. While genetics mayplay a role, the majority of

children are overweight dueto their environment and an

unhealthy lifestyle.Crtxiinu Konuuicloz. M.I).

manager with Nebraska Methodist HealthSystem. "It's about getting accurate informa-tion about diet and nutrition and the propersupport. For some children, that might beindividual counseling, while others might ben-efit more from group classes and support."

Nepper works with Life Shapes, a programsponsored by Nebraska Methodist HealthSystem that provides nutrition counselingand support for overweight and obese kidsand teens.

Nepper says it's a process that requiresboth the child and the parents to achieve thegreatest success. "Parent involvement is ex-

tremely critical," she says. "The parents arethe gatekeepers — they control what comesinto the house. The adoption of healthy hab-its, including diet and exercise, needs to startwith them."

Nepper adds that, oftentimes, just makingsmall dietary changes can help decrease ca-loric intake enough to halt weight gain andallow children to grow into their weight. Thisincludes steps like trading sugary beverages(like pop and Gatorade) with water, decreas-

Martha Nepper, MS, RD, LMNT, NebraskaMethodist Health System

ing portion sizes, increasing consumption offruits and vegetables, and having more fam-ily meals.

Some common things for parents toavoid include:

•Pressuring children to clean their plates

•Allowing children to have televisions intheir bedrooms

•Bringing too many energy-dense foodsinto the house, like cookies, chips, andtoaster pastries

•Not being a good role model by not exer-

cising regularly or participating in activi-ties that involve exercise with their children

• Eating out too often and too much fast foodUsing the U.S. Department of Agricul-

ture's (USDA) MyPlate is a great way to de-termine what should be on your child's plate,says Nepper. With MyPlate, half of the plateshould be fruits and vegetables with the re-

maining half split between proteins, wholegrains, and dairy.

Even after completing an interventionprogram, these children do best when theycome back for occasional follow-up visits."It's a lifelong battle," says Fernandez. "Asmoker or an alcoholic can stop using to-bacco or alcohol; we can't stop eating." j-JF|