Too much energy consumed, not enough burned. Regardless of age, this scenario adds up to a potential weight problem. Children need to exercise at least an hour a day, according to the latest guidelines issued by the Centers for Disease Control. They should spend at least an hour a day doing moderately intense activities, such as walking, swimming, or bicycling. But many don't.
Obesity used to be an adult disease, but kids are rapidly catching up. The prevalence of obesity among American children has tripled since the 1980s, closely mirroring the ongoing epidemic in adults.
Naturally, Happy Meals and Cocoa Crisps have played a large role in the wave of childhood obesity. But the real culprit seems to be a cultural shift, a new way of life that encourages kids to remain as still as possible, according to former U.S. Surgeon General David Satcher, who blamed child obesity on lack of exercise and an unbalanced diet.
"This is probably the most sedentary generation of people in the history of the world," Satcher said.
Melinda S. Sothern, PhD, exercise physiologist and director of the Pediatric Obesity Clinical Research Section at the Louisiana State University Health Sciences Center, agrees. Sothern is the lead author of Trim Kids, a book that helps parents raise active, healthy kids in unhealthy times.
According to guidelines from the National Association for Sports and Physical Education (NASPE), children between 5 and 12 need at least one hour of moderately vigorous exercise a day. These days, only 20 to 40 percent of American kids get that much.
Sothern has been working with overweight kids for 15 years, giving her a firsthand view of the dramatic decline in physical activity among youngsters. For one thing, kids today waste way too much time staring at screens, she says. According to the Kaiser Family Foundation, the average American child spends more than five hours a day -- or nearly 40 percent of their waking hours -- watching TV, playing video games, or sitting in front of a computer.
Sedentary schools
But home entertainment is only part of the problem. "Our school system must bear some of the blame," said Satcher. School districts across the country are cutting physical education programs, depriving many children their most reliable source of exercise. According to the Centers for Disease Control and Prevention, the number of high school students taking daily physical education classes declined 12 percent between 1991 and 2007. Currently, only two states -- Illinois and Massachusetts -- require daily PE classes for all kids in kindergarten through 12th grade. (But even in those states, schools allow exemptions.)
As elementary schools try to squeeze more academic instruction into each day, recess is becoming a luxury. "A lot of kids get a few minutes after lunch and that's it," Sothern says. In many ways, the demise of recess is even more troubling than the cuts in physical education programs, she says. Recess gives kids a chance to burn energy in their own way, and games of four square or catch are often more physically demanding than the activities in gym class.
Many parents and teachers have already tried to bring exercise back into children's lives, but others remain unaware of the problem, says Judy Young, PhD, executive director of the National Association for Sport and Physical Education. "Many people think that young kids are just naturally active," she says. "If anything, they're focused on getting kids to settle down."
But inactivity and obesity in childhood shouldn't be taken lightly. Eighty percent of obese 10- to 14-year-olds will likely grow into obese adults. Overweight, sedentary children are also vulnerable to "adult" diseases such as high blood pressure and type 2 diabetes. A study in The Lancet found that severely obese children already had stiff arteries, potentially making them vulnerable to atherosclerosis as adults.
Cutbacks in physical education and recess may also be fueling behavior problems in class, Young says. Many kids would be more attentive and successful in the classroom if they could let off steam on the playground, she says.
Getting proactive
All parents should encourage their kids to stay active, weight problem or not, Sothern says. She herself is pushing for more recess time at her 9-year-old's school -- something the federal government approves of. The federal government has recommended that all communities provide quality physical education classes for all grades -- "preferably daily" -- and hire physical education specialists to teach them.
Of course, speaking up at community and PTA meetings is only one step in the right direction. Parents also have to keep their kids moving at home, Sothern says. You don't need to junk the TV or invest in any fancy equipment. You just need to create an atmosphere where it's easy to be active.
For starters, parents should tap into their child's penchant for play. "Set up a soft mat in the den, keep some sports equipment in the backyard, put a box of dress-up clothes in the playroom -- anything to get them away from the TV," she says.
Parents should join in whenever possible, she says. They can take their kids on a walk or nature hike, throw around a football, ride bikes together, or do anything else that sounds fun. Not only will parents improve their own health, they'll also set a good example.
Children who are already overweight may need a more structured fitness routine. Unfortunately, several barriers stand in their way. For one thing, exercise may make them feel self-conscious. But even more important, it can bring on extreme discomfort and physical pain.
Overweight children have a much lower "exercise tolerance" than other kids, Sothern says. After five minutes of strenuous exercise -- about the time most kids start to get out of breath -- hefty kids may be hitting the wall. Their faces turn red, their breathing becomes extremely rapid, and lactic acid builds up in their muscles, causing intense pain. And all too often, there's an adult standing behind them, urging them to keep up with the others. "Coaches and parents often perceive physical difficulties as laziness," Sothern says.
Overweight kids should keep exercise slow and steady, especially at the beginning. Sothern has found that by combining moderate exercise with sensible eating patterns, most overweight kids can reach a healthy weight within six to 12 months. Up to 70 percent of the kids who enroll in her weight-loss program reach their long-term goals, she says.
Exercise programs
Sothern's book Trim Kids provides detailed examples of appropriate exercise programs for children of all sizes. Extremely obese kids, for example, can swim slowly or ride an exercise bicycle (with the resistance turned down to zero) for 20 minutes twice a week. These activities will help them shed pounds while sparing their joints. Kids who are only slightly overweight might try brisk walking, in-line skating, martial arts, or other weight-bearing exercises for 20 to 35 minutes three times a week. Over time, workouts can become longer and more intense.
Of course, parents don't have to go it alone. Pediatricians can help them set up an exercise and weight-loss program, perhaps with the assistance of a dietitian or an exercise physiologist.
When is the right time to call the doctor? Parents shouldn't worry too much about chubby toddlers, unless they seem lethargic or have an insatiable appetite, Sothern says. An overweight preschooler shouldn't cause much alarm either, assuming neither parent has a weight problem. But if there's a family history of obesity, it's a good idea to ask a pediatrician for advice. If a child is still overweight at age 5, parents shouldn't expect him to "grow out of it," she says. At this point, it's definitely time to do something.
Weight is a touchy issue at any age. Many parents are hesitant to bring it up, even as their children grow increasingly unhappy and unhealthy. But the benefits of slimming down far outweigh the discomfort of talking about it, Sothern says. Kids want to play, they want to run, and they want to stay healthy. And one of the first things they need is a push in the right direction -- away from the TV and out the door.
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