Fighting Childhood Obesity Through Community Help for Parents

Image of a scale from the U.S. National Library of Medicine

Percentage of kids, grades 9 - 12, who participate in physical activities
1991: 42%
2003: 28%
Source: U.S. Dept. of Health & Human Services

Estimated per capita expenditures to fight obesity:
Maine: $272
Massachusetts: $283
New Hampshire: $235
U.S.: $258
Source: Trust for America's Health

Obesity in Mass. kids, grades 1, 4, 7 and 11
Overweight: 17.2%
Obese: 17.5%

Obesity in NH kids, grades 1 - 13 (between 2004 and 2007)
Overweight: 19.1%
Obese: 20.15%

Obesity in Maine school children (small sample, kindergarteners and 3rd graders in 2005)
Overweight: 17.9%
Obese: 17.5%

Source: Child and Adolescent Health Measurement Initiative. 2003 National Survey of Children's Health, Data Resource Center for Child and Adolescent Health (Web site), www.nschdata.org.

(Updated 8 July 2008)

If Kátia Oliveira truly believed that "chubby kids are cute and healthy kids," her concerns would be unfounded.

The popular saying, which she recalls from her homeland of Brazil, was used to comfort parents who struggled with their kids' malnutrition in poor South American cities.

But Oliveira is a parent who lives in Framingham, Mass. She worries that her daughter, Isabella, has been drastically gaining weight since age 2.

It is not uncommon for entire immigrant families to become overweight just a few months after migrating to the U.S.

According to a Harvard Pilgrim Health Care Foundation study that surveyed 94,000 kids in 2006 and 2007, 17.2 percent of children in grades 1, 4, 7 and 11, are overweight; and 17.5 percent are obese.

In the United States, one in every three children is overweight. Doctors say untreated childhood obesity can easily lead to heart problems, asthma, and diabetes in adulthood.

Oliveira says her family in Brazil has no history of obesity. However, with her husband and father developing diabetes, she quickly assumed the role of Food Police for her kids, Isabella, 10, and Israel, 7.

She counts on specialists to help her change her children's diet habits.

"We don't promote drastic changes, but we'll gradually take some items away, and add others. Like, a muffin has 500 calories, an English muffin, 150. The family's rhythm is respected. We don't really want them to diet, but to change habits," says Cris Sciaba.

Sciaba is a patient advocate for KidsCare Connection, a program managed by the South Middlesex Legal Services, a non-governmental organization.

The program helps children in the Framingham area gain access to services such as primary care, mental health, dental and vision. It also provides assistance to parents, helping them navigate the health care system.

Sciaba met Oliveira through a referral by a doctor from Southborough Medical Group. Soon after, Sciaba became a topic at family dinner-table talk.

"I tell my daughter, ‘Did you hear what Cris said - no juice, and you have to eat fruits and vegetables'," recalls Oliveira.

Registered dietitian Suzanne Rostler, MS, RD, agrees that juices can harm a child's diet and lead to obesity.

"Studies show that our body doesn't register sugar from liquid the same way it does from solid food. A child can have 1,000 calories in a few cups," said Rostler, who works for the Optimal Weight for Life Center, an outpatient clinic to treat obese kids and their families at Children's Hospital Boston.

"It doesn't matter if the juice is natural, it has the same effect on weight," she adds.

Rostler, a co-author of "Ending the Food Fight," recommends two major steps any household needs to fight child obesity.

"Keeping a safe food environment, getting rid of junk food, and parents have to be role models. A child is not going to succeed unless the whole family will do it, too," she says.

In Oliveira's home, everybody has adopted the soy hamburger Isabella likes. But her father works long hours at Whole Foods Market, and her mother cleans two car dealers in Natick, so the at-home calorie inspection tends to relax a bit.

That can lead to problems.

"If you grew up in rural Costa Rica you could pick up mangos in your backyard, here [it] is expensive. Also, in lower-class communities there are not as many supermarkets, or mom-and-pop shops. But you see lots of fast-food restaurants. Adopting the American lifestyle makes it impossible for them to keep the style they left behind," says Jeanne Goldberg, director of the graduate program in Nutrition Communication at Tufts University.

She says the academic community must participate in the battle against child obesity. One way Tufts is doing it is by encouraging undergraduate students to interact with local immigrant communities. In March, they participated in weekly salsa classes for patients of the East Somerville Health Center, in Massachusetts.

The university also took a leading role in last year's Shape Up Somerville program. The multi-level intervention was praised by the Wall Street Journal as a successful effort that "took more than will power, but the will of an entire community."

The Shape Up program was a joint effort of Mayor Joseph Curtatone's office, state health officials, schools, parents, and the business community, which targeted the high rate of obesity amongst minorities. The program gave away 10-week gym memberships and defined what a portioned healthy plate is, which helped change the habits of 2,281 students, in grades 1 through 3.

The Somerville program is one of numerous similar efforts in Massachusetts. A study called "Trust for America's Health" showed that Massachusetts spends more ($283 per person) to fight obesity than the national average ($258).

Jesse Branth, a patient advocate at Cambridge Health Alliance, says that the Shape Up results still resonate.

At East Somerville (Mass.) Health Center, he encourages Latino and Brazilian parents to adopt a "5-2-1 program," which recommends 5 daily doses of fruits and vegetables, 2 hours or less of TV and computer exposure, and 1 hour of physical activity as part of the Jump Up & Go program.

For Cris Sciaba, efforts to combat obesity have to be coordinated with mayors and local officials.

"It's cheaper for the state if we work with prevention. Because today's kids' unhealthy habits can lead up to asthma, diabetes, and more hospital visits tomorrow," says Sciaba, who frequently offers financial assistance for patients to attend gym classes.

In Somerville, Branth goes as far as accompanying families in a supermarket visit.

"We watch their buying habits, and at the end of a market visit we talk about healthier options to the products they like to consume," says Branth.

When it comes to educating their children, says Branth, parents are hungry for guidance, at least in the Somerville-Cambridge area.

But some parents resist the efforts to help, Sciaba says.

They prefer to ignore that their kids are becoming overweight. Because admitting obesity would be admitting they are guilty," she says.

Oliveira enrolled Isabella in Capoeira (Brazilian dance/martial art) classes. But the girl abandoned it after the first day. Oliveira says she won't give up; she likes to brag that granola bars are already part of her daughter's voluntary diet.

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PARENTS:  WHAT HAS HELPED YOU IN TAKING CARE OF OVERWEIGHT CHILDREN?
ANY ADVICE FOR OTHER PARENTS?

HEALTH PROFESSIONALS: 
WHAT'S YOUR EXPERIENCE IN WORKING WITH KIDS/PARENTS IN IMMIGRANT FAMILIES?
ANY CULTURAL BARRIERS?  HOW DID YOU OVERCOME THEM?

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source: EthnicNewz.org

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SEE ALSO:
Obese Latino Youth May Be At Risk for Diabetes and Heart Disease as Young Adults