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NEWS & TIPS
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A Crisis of
Great Magnitude
Nayer
Khazeni, M.D.
Sunday,
August 26, 2007
Even when
obesity was associated with affluence in Shakespeare's day, the playwright
noted his overweight characters' failing health: "Thou seest I have more
flesh than another man, and therefore more frailty."
Today,
cutting across all income groups, obesity remains a dangerous medical
condition and a national public health crisis, costing Americans $100
billion in health care expenditures and more than 400,000 premature deaths
each year. A number of studies have now demonstrated links between obesity
and a host of medical conditions, including depression, gastroesophageal
reflux, sleep apnea, gout, osteoarthritis, gallbladder disease, kidney
disease, diabetes, high blood pressure, high cholesterol, coronary artery
disease, heart failure, atrial fibrillation, stroke, pulmonary
hypertension, blood clots, dementia and several cancers (endometrial,
breast, pancreas, kidney, esophageal, multiple myeloma, lymphoma,
prostate, liver and colon).
A July 2007 study from the Johns Hopkins Bloomberg School of Public Health
estimates that 75 percent of American adults and 24 percent of American
children will be overweight or obese by 2015.
During my residency, patients weighing more than 325 pounds used to be
transferred from the hospital to local zoo scanners for imaging. Even with
newer machines that accommodate larger patients, radiologists need to use
high levels of radiation to acquire images because of increased body mass.
Scanners designed for patients weighing as much as 615 pounds are in the
works.
The World
Health Organization and National Institutes of Health use body mass index
as a clinical tool for assessing obesity. To calculate your BMI, multiply
your weight (in pounds) by 703, and divide by your height (in inches)
squared. A BMI of 18.5 to 24.9 is normal, greater than 25 is overweight,
and greater than 30 is obese.
Obesity in
the United States increased 30 percent since the 1970s, with the Hopkins
study concluding that 66 percent of adults and 16 percent of children are
overweight or obese. Why such a steep increase? Changes in diet and
lifestyle (increased fast food consumption and increased portion sizes of
restaurant food, grocery products and cookbook recipes, plus driving and
computer use) contribute to the problem. Additionally, a study this month
in the New England Journal of Medicine demonstrates how changing social
perceptions of normal weight may start a "contagious" cycle: People had a
57 percent increased risk of becoming obese if a friend did. Dramatic
increases were also noted with spouses and siblings.
Certain
medications and endocrine disorders can play a role in developing obesity,
as can genetics. But the majority of cases are related to a sedentary
lifestyle and increased caloric intake. Lifestyle interventions that
include diet, exercise and behavior modification are highly effective in
weight loss. It doesn't take much to improve your health: Studies have
shown significant reduction in obesity-associated disease risk with as
little as 5 percent weight loss. Five percent weight loss in six months is
a realistic goal; many patients achieve much higher amounts.
If you have
a weight problem, take an active role in fighting weight-linked illnesses
by scheduling an appointment with your physician to design a weight loss
plan. While waiting for your appointment, start brisk walking for 20
minutes five times a week and record your calorie intake (your treatment
plan will probably include a 1,200 calorie/day diet). Take stairs rather
than elevators, and walk instead of driving whenever you can. Your doctor
may prescribe drug therapy in addition to diet and exercise. If you have a
BMI greater than 35, you may qualify for bariatric surgery.
There are
many risk factors for disease over which we have no control, but in most
cases, weight is not among them. So, reverse the contagion: Get yourself,
and by proxy, your friends, family and our nation back in shape!
Dr. Nayer
Khazeni specializes in internal medicine and pulmonary/critical care,
teaches and conducts research at Stanford University Medical Center.
This article appeared on page P - 6 of the
San Francisco Chronicle
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Ways to Help Your Child Develop Good Attitudes
about Eating
·
Don't place your child on a restrictive diet
Children should
never be placed on a restrictive diet to lose weight, unless a doctor
supervises one for medical reasons. Limiting what children eat may be
harmful to their health and interfere with their growth and development.
To promote proper growth and development and prevent overweight, parents
should offer the whole family a wide variety of foods from each of the
food groups displayed in the Food Guide Pyramid. If you are unsure about
how to select and prepare a variety of foods for your family, consult a
physician or registered dietitian for nutrition counseling. You may also
want to refer to the recommended books listed at the end of this guide for
more information on healthy eating.
·
Carefully cut down on the amount of fat in your family's diet
Reducing fat is
a good way to cut calories without depriving your overweight child of
nutrients. Simple ways to cut the fat in your family's diet include eating
lowfat or nonfat dairy products, poultry without skin and lean meats, and
lowfat or fat-free breads and cereals. Making small changes to the amount
of fat in your family's diet is a good way to prevent excess weight gain
in children: however, major efforts to change your child's diet should be
supervised by a health professional. In addition, fat should not be
restricted in the diets of children younger than 2 years of age. After
that age, children should gradually adopt a diet that contains no more
than 30 percent of calories from fat by the time the child is about 5
years old.
·
Don't overly restrict sweets or treats
While it is
important to be aware of the fat, salt, and sugar content of the foods you
serve, all foods-even those that are high in fat or sugar-have a place in
the diet, in moderation.
·
Guide your family's choices rather than dictate foods
Make a wide
variety of healthful foods available in the house. This practice will help
your overweight children learn how to make healthy food choices.
·
Encourage your child to eat slowly
A child can
detect hunger and fullness better when eating slowly.
·
Eat meals together as a family as often as possible
Try to make
mealtimes pleasant with conversation and sharing, not a time for scolding
or arguing. If mealtimes are unpleasant, children may try to eat faster to
leave the table as soon as possible. They then may learn to associate
eating with stress.
·
Involve children in food shopping and preparing meals
These activities
offer parents hints about children's food preferences, teach children
about nutrition, and provide children with a feeling of accomplishment. In
addition, children may be more willing to eat or try foods that they help
prepare.
·
Plan for snacks
Continuous
snacking may lead to overeating, but snacks that are planned at specific
times during the day can be part of a nutritious diet, without spoiling a
child's appetite at mealtimes. You should make snacks as nutritious as
possible, without depriving your child of occasional chips or cookies,
especially at parties or other social events. Below are some ideas for
healthy snacks.
·
Discourage eating meals or snacks while watching TV
Try to eat only
in designated areas of your home, such as the dining room or kitchen.
Eating in front of the TV may make it difficult to pay attention to
feelings of fullness, and may lead to overeating.
·
Try not to use food to punish or reward your child
Withholding food
as a punishment may lead children to worry that they will not get enough
food. For example, sending children to bed without any dinner may cause
them to worry that they will go hungry. As a result, children may try to
eat whenever they get a chance. Similarly, when foods, such as sweets, are
used as a reward, children may assume that these foods are better or more
valuable than other foods. For example, telling children that they will
get dessert if they eat all of their vegetables sends the wrong message
about vegetables.
·
Make sure your child's meals outside the home are balanced
Find out more
about your school lunch program, or pack your child's lunch to include a
variety of foods. Also, select healthier items when dining at restaurants.
·
Set a good example
Children are
good learners, and they learn best by example. Setting a good example for
your kids by eating a variety of foods and being physically active will
teach your overweight child healthy lifestyle habits that he or she can
follow for the rest of their lives.
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Exercise and Children - American Heart Association Scientific Position
August 27, 2007
Physical
inactivity is a major risk factor for developing coronary artery disease.
It also increases the risk of stroke and such other major cardiovascular
risk factors as obesity, high blood pressure, low HDL ("good") cholesterol
and diabetes. The American Heart Association recommends that children and
adolescents participate in at least 60 minutes of moderate to vigorous
physical activity every day.
Why is exercise or physical activity important for my
child?
Increased physical activity has been associated with an
increased life expectancy and decreased risk of cardiovascular
disease. Physical activity produces overall physical, psychological and
social benefits. Inactive children are likely to become inactive adults.
And physical activity helps with:
·
controlling weight
·
reducing blood pressure
·
raising HDL ("good") cholesterol
·
reducing the risk of diabetes and some
kinds of cancer
·
improved psychological well-being,
including gaining more self-confidence and
higher self-esteem
How do I promote physical activity in my child?
Physical activity should be increased by reducing sedentary
time (e.g., watching television, playing computer video games or talking
on the phone)
Physical activity should be fun for children and adolescent
Parents should try to be role models for active lifestyles
and provide children with opportunities for increased physical activity.
What if my child is uncoordinated or overweight?
All children, even less-coordinated ones, need to be
physically active. Activity may be particularly helpful for the physical
and psychological well-being of children with a weight problem.
The American Heart Association recommends:
All children age 2 and older should participate in at least
30 minutes of enjoyable, moderate-intensity physical activities every day
that are developmentally appropriate and varied.
If your child or children don't have a full 30-minute
activity break each day, try to provide at least two 15-minute periods or
three 10-minute periods in which they can engage in vigorous activities
appropriate to their age, gender and stage of physical and emotional
development.
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