CHILDHOOD OBESITY

Questions and Answers about a national epidemic

An interview with Goutham Rao, M.D. clinical director of the Center for Weight Management and Wellness at Children’s Hospital of Pittsburgh

By Jack Etzel

If you think that you see more overweight kids these days than a generation ago, it’s not your imagination. Even the statistics are huge. Professionals researching this problem estimate that there are more than 9 million young Americans who fall into that category.

A nationally recognized leader on this subject is Goutham Rao, M.D. Doctor Rao is the clinical director of the Center for Weight Management and Wellness at Children’s Hospital of Pittsburgh. Among his many published writings is a book titled Child Obesity: A Parent’s Guide to a Fit, Trim, and Happy Child.

North Hills Monthly Magazine: Doctor Rao, when should a parent become concerned that their child is overweight?

Dr. Rao: We’d like to see parents concerned about weight and nourishment even before they’ve had children. Good nutrition starts with mom while she’s pregnant. Breastfeeding is one of the best ways to prevent obesity later in life. It’s very protective against obesity. As for when (they should be concerned), that’s something that should come to them (the parents) through their physician, and would be at about age 2 years old. You can have a chubby baby, but about 2 or 2 1/2 years old is the time when a problem can come up.

NHMM: How do you differentiate between a child carrying some so-called baby fat and obesity?

Dr. Rao: We use the standards of the Centers for Disease Control. When a child is in about the 95th percentile of something called the Body Mass Index that means that they are officially over-weight and that they have a problem. That’s regardless of what they look like.

NHMM: Let’s get basic. Why should we consider childhood obesity so important?

Dr. Rao: Ten years ago, they would have said that it’s important as a risk factor because it will lead to adult obesity, which in turn could lead to heart disease and other problems. But, now it’s become more important because they are developing problems in childhood. We’re seeing more children with Type-2 diabetes, with sleep disorders, with breathing problems, and cases of depression. These things are affecting their quality of life. In addition, this is causing an enormous amount of money (to be spent) from all of us to look after them.

NHMM: When I’ve observed an obese child, sometimes the parent has the same body type, and the parent is also obese. Is this often familial?

Dr. Rao: It’s familial in the sense that the parent has created the environment in which the child lives, especially a younger child, so the parent’s habits, the food, everything is also consumed by the child. But, to some degree, eating habits are genetic. Appetites are inherited to some extent. In that case, an overweight parent is more likely to have a child who is predisposed to obesity.

NHMM: When parents bring in an obese child, what are some of the things you say to them?

Dr. Rao: The first priority is to make sure that they don’t have any medical problems related to obesity. We check for high cholesterol, high blood pressure, diabetes, and sleep disorder. We see a lot of those things, as well as attention deficit disorder and depression. If we didn’t do that, they wouldn’t feel well, and wouldn’t be able to do a lot in order to lose weight.
The second step is to identify behaviors that are leading to the problem. Only a very, very small proportion of kids have some kind of underlying metabolic problem. That’s about one-half of 1 percent. We identify what behaviors are creating this obesity. We don’t say, “You need to lose 20 pounds in the next couple of months.” We tell them you have to cut down on your soft drink consumption by 80 percent, for example. We set goals with these patients for those particular behaviors. So, that’s the starting point. Then we have them come back in about three months to see how they’re doing.

NHMM: So, childhood obesity is more than just a physical problem.

Dr. Rao: Absolutely. It has a big impact on social functioning, and psychological well-being.

NHMM: Finally, can you put in a nutshell a list of the most significant causes of childhood obesity?

Dr. Rao: That’s easy. I’ve written about the five behaviors that lead to childhood obesity in my book. Number 1 is soft drinks, and other sweet beverages. Number 2 is how often does the child eat fast food? Number 3 is how many hours of media time do they have in a day? That’s not just television, but also the Internet, iPod, video games and the like. Number 4 is how often do they eat together as a family? A child who eats together with at least one parent fewer than three times a week is more likely to be obese. There aren’t controls over what they’re eating. Finally, it’s about how much habitual activity they get. That’s not how often they had gym class, or how many sports they’re involved in. A lot of our obese children play four or five different sports. When you factor in the time spent in the locker room, the changing of clothes, the chattering and talking, eating on the sidelines, it often offsets the physical activity. It’s walking, playing outside, for example. If you can change at least one of those things, the child is going to lose weight.

Note: To contact the Weight Management and Wellness Center at Children’s Hospital, telephone 412-692-8041 or visit http://www.chp.edu/clinical/03a_weightmanage.php