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Published on September 19, 2016

Kids’ waistlines grow as their activity levels dropKids’ waistlines grow as their activity levels drop

Watching kids run, jump and swim at the beach this summer makes you wonder how any child could be overweight. But, according to the Centers for Disease Control and Prevention, (CDC) obesity in American children continues to be a concern.

Obesity rates more than doubled in children and quadrupled in adolescents in the past 30 years, according to the CDC, and a lack of regular activity has a lot to do with it.

“The ideal goal is 60 minutes a day,” said Sharon Daley, MD, a pediatrician at Seaside Pediatrics in West Yarmouth. “But children today are less likely to have unstructured outdoor play, so they are doing sedentary activities inside instead. If families can find something fun that they can do together, it’s good for the whole family. Things like bike riding or taking hikes are great.”

The Alliance for a Healthier Generation lists a number of factors, including lack of exercise, that contribute to what some are calling an epidemic of obesity in children. Other contributors they cite include:

  • Too much screen time
  • The marketing of unhealthy foods
  • Increased portion sizes
  • A higher consumption of sugary beverages

Get Out and Play

Previous generations spent twice as much time playing outdoors as the current generation. They also spent a lot more time in gym class. In the 1960’s and 70’s many schools had daily physical education, thanks to President John F. Kennedy’s challenge to become a more fit nation, followed by President Lyndon B. Johnson’s Presidential Physical Fitness Awards.

Elissa Thompson, MD, a cardiologist at The Cardiovascular Center in Hyannis sees the ravages of obesity up close. She has patients who have had heart attacks in their 20’s because of a combination of obesity and diabetes.

“It really is frightening,” she said. “It’s still not fazing people that children are developing chronic diseases like Type 2 diabetes. It’s a hard thing for a child to learn to deal with – not just having a disease, but having something chronic that they have to deal with for their entire lifetime.”

While most states mandate some form of physical education, currently only six states adhere to the National Association of Sports and Physical Education guideline that schoolchildren get 150 minutes of it every week. Only three states have 20 minutes of mandatory recess a day. Massachusetts is not one of those states.

Pediatricians are well aware of this problem. When you walk into the waiting room at Seaside Pediatrics, a large display on the wall recommends 60 minutes of exercise a day with suggestions like jumping rope, chasing bubbles and dancing to your favorite song. But despite the suggestions, Dr. Daley said that most children are not getting enough exercise.

Prevention of obesity needs to be a focus for pediatricians, but it’s hard because of the many factors that contribute to it, she said. In addition to poor diets and lack of exercise, she also noted a more sensitive topic that is harder to address.

“Parents who are overweight may not perceive their children as overweight,” she said. “I always tell parents you’re supposed to see a little bit of rib. If you are seeing rolls around the middle, you need to be concerned.”

Cardiovascular Problems Are Showing Up Earlier in Life

The health problems that arise from obesity are indeed a concern. In addition to causing diseases like diabetes and high blood pressure, being overweight as a child or teen can lead to cardiac issues. A study recently published in The New England Journal of Medicine found that obesity in adolescence was associated with substantially increased risk of cardiovascular outcomes in middle age, particularly death from coronary heart disease.

The study followed 2.3 million male adolescents conscripted into the Israeli armed forces from 1967 through 2010. They discovered that those with a body-mass index in the 50th to 75th percentile during adolescence, which is still considered within the normal range, had significantly increased cardiovascular disease and mortality during the 40 years of follow-up. Those with higher BMI’s fared even worse.

A nearly identical study of 1.6 million late adolescent boys in Sweden from 1968 through 2005 showed the same dangers. The risk of heart failure was detectible even at body weight levels considered to be normal. For men with a BMI of 20 or higher the risk of heart failure in middle age increased by 16 percent with every additional BMI unit, after adjusting for factors that could affect the results.

Men with a BMI of 20 to 22.5 had a 22 percent increased risk of heart failure compared to men with a BMI between 18.5 and 20 in 1968. The risk nearly doubled for those with a BMI between 22.5 and 25 and more than tripled for those with a BMI between 25 and 27.5. Those classified as obese with a BMI between 30 and 35 had a six-fold increase and those with a BMI of 35 or more had a ten-fold increase.

One of the important points about the studies is that they were done before the obesity epidemic exploded, Dr. Thompson noted. Now that obesity rates are so much higher, she sees a big problem ahead.

“This obesity epidemic is going to have a profound impact on all of us,” she said. “We talk about how the baby boomers are aging and now we have to deal with this huge elderly population. Now we’re looking at young people who are going to have, quote, ‘elderly problems’ at the same time.”

Dr. Thompson runs the Healthy Parks, Healthy People walking program sponsored by Cape Cod Healthcare and Cape Cod National Seashore that promotes health and wellness. This year they plan to focus on attracting families and children, she said.

Will More Physical Education Time in Schools Help?

Dr. Thompson is also a huge advocate of an increase in the amount of time children spend in physical education at school.

“If we’re saving school budget money now by cutting out gym class and decreasing organized sports, we’re going to pay more in healthcare costs later,” she said. “It’s going to have significant ramifications as these children age into their 30’s and 40’s, not their 60’s and 70’s.”

Nauset Regional High School Assistant Principal Keith Kenyon said statewide testing and the Common Core have improved academic outcomes at many schools, but it has come at the expense of exercise.

“We’re fortunate at Nauset because we have 85-minute blocks and we have four a day, so when we do have gym classes, we really try to maximize them,” said Kenyon, who is also department chair of physical education and health for the Eastham school.

The school has an expansive Wellness Center donated by Trish and Tom Kennedy that opened its doors in 2007. The center has cardiovascular equipment such as weights, treadmills, elliptical machines, stationary bikes and spinning bikes.

“It’s been a really good thing,” Kenyon said. “Our fitness center is open before school, during school for all four blocks, and afterschool. We have a lot of kids who exercise.”

Students at Nauset are required to take at least a half a year of physical education all four years of high school. The PE department has tried to move away from an emphasis on the “ball” sports like basketball, volleyball and soccer in gym classes because students who are interested in those sports have opportunities to play them on afterschool sports teams at the school and through town recreation departments.

“We have a great outdoor education program,” Kenyon said. “Our kids go hiking, they go paddle boarding, they go kayaking, they go biking on the trails. We are teaching them things that they will hopefully enjoy and continue doing as adults.”

In addition to educating students about physical fitness and eating well, beginning next year the school plans to turn some of the health classes into fitness sessions. They already test kids for heart rate and body fat.

“I think the message is pretty consistent,” Kenyon said. “We got rid of all of our vending machines with sugary drinks. We have filtered water that is available for free in our cafeteria. Our school is full of kids walking around with water bottles all day long.”

Nauset alumnus Katie Daley graduated in 2014. While she was a student, she enjoyed going to the fitness center with her friends and said that a lot of students used it.

“I think that it was really nice because it was free and going to the gym is expensive,” Daley said. “The fitness class really gave kids knowledge on how to get healthy. I think it helped a lot of kids who didn’t know how to get physically fit on their own.”