It’s not a regular topic of conversation. In fact, most parents would rather shy away from the subject altogether. But the rate of obese and overweight children continues to rise — whether we want to talk about it or not. Indiana has the ninth highest obesity rate for youth ages 10 to 17, according to the newly released 2018 State of Obesity Report, and that number continues to grow.
How did we end up here?
In order to find a solution, one must first identify what has caused the problem.
Many of us could easily list reasons why childhood obesity continues to be a pervasive issue — lack of exercise, fast food, unhealthy lifestyles — and all of those answers would be right.
Obesity is caused by a variety of issues, which are different for every person. That, say experts, makes it challenging to approach.
Obesity, calculated in primary care settings by body mass indexes (BMI), is a condition characterized by an excessive amount of fat in the body. North Central Indiana Pediatric physician Dr. Fatima Saad said for younger patients, pediatricians plot weights on growth charts because children are constantly in a state of growth.
“We compare children to their peers in that specific age group,” she said. “I consider a child overweight if their BMI is above the 85th percentile and obese if they are above the 95th percentile.”
As a physician, Saad said when a patient is brought to her with a weight issue she focuses on what patients can actively change.
“The nice thing about it is that we can counsel patients and we can create treatment plans for the modifiable causes of obesity,” she said. “It’s very easy to have this ‘blame tone’ directed towards parents or family, so for me, it’s very important to show them that this is a problem we can solve as a team or hand-in-hand. The patient, the doctor and the caregiver should all be on the same page.”
Lindsey Bouza, director of the Division of Nutrition and Physical Activity at the Indiana State Department of Health, agreed that while some poor lifestyle choices can be avoided, there are larger issues that factor into weight gain from food industry standards to lack of education.
“There are lots of reasons our division, other states and the CDC (Center for Disease Control and Prevention) look to as the reasons for the increasing rate of obesity — it’s not just one or two reasons,” Bouza said. “We definitely know that sedentary lifestyle and physical inactivity are risk factors for obesity in youth. Some contributing factors to that include reliance on television, computers, tablets and cellphones, which really increases physical inactivity so there’s less kids playing out and about outside for example, if they are inside playing on their phone.”
The inactivity has continued to spread to schools, Bouza said, with fewer students participating in physical education classes. According to the 2015 Indiana Youth Risk Behavior Survey, 74.7 percent of high school students were not physically active for at least 60 minutes a day each week, and 72 percent did not attend physical education classes on all five school days.
“Also 22 percent report watching television for three or more hours per day, and 38 percent report using computers or video games three or more hours a day, so there’s some competing factors with being outside and being active,” Bouza continued.
In addition to the lack of activity, dining out has become problematic, both with portion sizes, sugary drinks and the lack of nutritional value in fast food.
“When you go to a restaurant, typically the meal is two or three servings worth, really, so a suggestion we always give is to ask for a box right away and take half of it home,” Bouza said. “There has also been an explosion of fast food restaurants and less farmers’ markets and farm stands.”
Bouza said a lot of families have two working parents, with some working more than one job, so there is less time available to make home-cooked meals.
“Unfortunately, sometimes it’s just easier, quicker and cheaper to pick up fast food on the way home,” she said.
In 2009, health and state officials began working on a comprehensive nutrition and physical activity plan called the “Indiana Healthy Weight Initiative.”
Beginning in 2010, the initiative’s task force was implemented to achieve six main goals:
• Increase access to and consumption of healthy food and beverages;
• Increase opportunities for and engagement in regular physical activity;
• Increase efforts aimed at enabling people to achieve and maintain a healthy weight across a lifespan;
• Reduce environmental and policy-related disparities for breastfeeding, nutrition, physical activity, overweight, obesity and chronic disease;
• Increase the capacity of communities and setting within those communities to develop and sustain environmental and policy support systems that encourage healthy eating and active living;
• And increase state and local strategic partnerships to more effectively coordinate efforts, share resources and identify and reach priority populations.
In order to accomplish those goals, the plan outlined measurable progress, including increasing the percentages of people meeting healthy weight standards and increasing the percentages of physically active people.
Bouza said the state health department has been working with the coalition to help provide resources to child-care providers, school districts and communities.
“One part of the Healthy Weight Initiative that is really active is called the ‘Healthy Schools Action Team’ and it’s a committee made up of statewide school health leaders and they are really trying to implement the ‘Whole School, Whole Community, Whole Child’ motto,” she said. “It’s really about looking at everything that can touch a child while they’re at school that could affect their health — whether it’s school counseling, physical activity, nutrition, mental health services or family and staff involvement.”
A success to some of these overarching goals can actually be measured in children enrolled in the Special Supplemental Nutritional Program for Women, Infants and Children (WIC). In Indiana, obesity rates declined among 2- to 4-year-olds from 15.1 percent to 14.3 percent in a four-year period. WIC has registered dietitians on staff who can tailor nutrition for those children and address the issue of obesity if needed.
“Research has shown that breastfeeding reduces the risk of obesity in children, so our Indiana WIC program has definitely grown its breastfeeding program in the last three to five years,” Bouza said.
In addition to the improvements made in schools and state-funded programming, Bouza said many communities are tackling the issue head-on. The state health department has been hosting “Active Living Workshops” in communities across the state for the past five years.
“We don’t have mountains or beaches in Indiana, really, so there’s not as much funding put towards infrastructure to make more walkable and bikeable communities,” she said. “We are looking at trying to create healthy environments — having better physical infrastructure out there like bike lanes and sidewalks and parks — so families can be more active together.”
One city that took a proactive approach was Lebanon, Bouza said, which hosted a public open house in addition to a workshop held in 2014.
“They really heard about the value of having better infrastructure in their city when it comes to bike lanes, sidewalks, connectivity and social cohesion,” she said. “They also had an active mayor, and with that they were able to get money put in a line item for active-living improvements within their city budget.”
In the past five years there have been 46 Active Living Workshops, and cities such as Madison,Crawfordsville and Washington have been implementing changes to improve.
What of obesity increases?
Part of the solution also includes educating parents and others within the community of the consequences if obesity persists.
“It’s a huge problem because a lot of the children that are obese will become obese adults,” Dr. Saad said. “Parents might not know that obesity has long-term side effects on health.”
Indiana is currently ranked 11th highest in the U.S. for its adult diabetes rate of 11.8 percent. According to the State of Obesity Report, the more than 544,000 cases of diabetes reported in 2010 is projected to increase to more than 814,000 by 2030 if things don’t change. Hypertension is also projected to increase by nearly 400,000 cases within the next 10 years and obesity-related cancer cases are projected to double.
So what can you do?
If you’re a parent, Saad and the American Academy of Pediatrics recommends introducing five servings of fruits and vegetables in your child’s diet. She also recommends choosing less processed foods and cooking more meals at home, limiting screen time to no more than two hours a day, and encouraging kids to get involved in sports or other club activities.
Many parents struggle with picky eaters who simply refuse to eat healthy foods. The key to getting them to eat vegetables is to offer the child options, Saad continued, like broccoli or green beans, an apple or orange.
Children will also be reluctant to follow a healthier diet if other members of the family continue to eat the fast food, so it needs to be a commitment from the whole family to eat healthier and be more active, she noted.
“It takes commitment on all levels from all family members,” Saad said. “It’s a long process — there’s no magic in this.”
Bouza shared a similar sentiment.
“It took us 30 years to get to this point, so it will most likely take 30 years or more to get back to where we were in terms of obesity rates,” she said. “But even a 1 percent decrease in adult obesity is 50,000 people that are healthy again.”