In Massachusetts, 34 percent of school-aged children are overweight or obese, according to a Harvard Pilgrim Health Care Foundation study.

Medical professionals determine if a person is overweight or obese by his or her BMI, or body mass index, which is a comparison of one's height to his or weight. If a person's BMI is between 25 and 29.9, he or she is medically oveweight; 30 or higher, she or he is obese.

Over the last decade, the Medical Security Plan, a state-sponsored program, has guaranteed treatment to all Massachusetts children, including those who are undocumented.

Jerry M. Wortzman, MD, chief of pediatrics at Metrowest Medical Center, in Framingham, Mass., has sounded the alert: Today, fewer exercise sessions (sometimes called "gym" or "P.E.," meaning "physical education") are being offered to students in the schools of Framingham.

Nationwide, 52 percent of American children ages 6 to 17 do not exercise regularly, according to the U.S. Centers for Disease Control and Prevention (CDC).

Dr. Wortzman, who has 25 years of pediatric experience, knows well the problem of obesity among children, incluing those from immigrant families.

Two thirds of his patients are of Brazilian or Hispanic descent - which perhaps is no surprise considering that one third of Framingham's residents are immigrants, according to MassInc., a nonprofit that specializes in urban research.

In an interview with EthnicNewz.org, Dr. Wortzman confessed to being "greatly disturbed" by a surprising trend: Obese kids are so prevalent in school yards that fewer are considered "different" by their peers.

"You don't wish for any kid to have problems socially, but on a global level, it reflects the magnitude of the problem," he said.

Following are edited excerpts from the interview, which took place on Friday, July 11, 2008, at Dr. Wortzman's office in Framingham.

How do you fight the non-exercising culture that kids are engaged in now?

It's very much a societal problem and it needs a community approach. But the MetroWest Health Care Foundation (which was born out of the merger of the two major hospitals in Framingham) is constantly funding local programs to fight childhood obesity.

That way, families in the community are connected with medical professionals who can advise them.

[Editor's note: The MetroWest Health Care Foundation is a funder of the health beat of EthnicNewz.org.]

According to the Harvard Pilgrim Health Care Foundation, 34 percent of Massachusetts school-aged children are either overweight or obese. What are the most common diseases these kids may develop in adulthood?

Well, the list is very long, because obesity affects almost every system in the body.

But the most common (diseases or conditions) we worry about are diabetes, high blood pressure, high cholesterol and lipid [blood fat] problems, which eventually lead to heart disease and strokes.

Do you think that implementing preventive programs for children is cheaper than treating them in adulthood?

It probably is. Most chronic disease follows that model, prevention being cheaper than treatment.

The challenge is the way our society is organizing, who pays for complications, and who pays for prevention for different people? Those benefiting (from financial) savings aren't those investing the money in the front end.

(Insurers and providers have different vested interest. As in health care reform, the trouble is combining those interests.)

We should be focusing at the community level. (Health is not just the responsibility of providers).

Are you talking about the entire family or just the child?

Right, in our (pediatricians') case, it's not just the individual, it's the family.

Children are vulnerable to (fast food) advertising. What can you do as the medical professional?

As an individual provider, it's very difficult because the assessments I make with the families are to find out how informed they are (about their own health) and to show them how they can make the changes they need.

But, to tell you the truth, the vast majority of the parents are not psychologically ready to make those changes.

What about the cultural barriers you encounter with the parents? How can they understand the treatment needed?

I don't a see a significant difference in terms of the likelihood of children being obese among Brazilians, as opposed to Latinos or my American patients (from non-immigrant families).

Just from working every day, I notice they are all influenced from the same cultural environment. I've read about overindulgent parents, which is occurring across the ethnic spectrum.

Do you think parents have to be role models?

I am not sure how to answer that. But we certainly know that the parent being obese, that is a demonstrated risk factor for the child being obese.

That speaks to whatever the genetic component is, and to the environment, too.

So genetics and behavior are rolled into one. Universally, kids emulate their parents.

What about the psychological aspects of obesity? Are kids still having lower self-esteem because they're teased at school?

That's an issue, (but) a number of my very-obese young patients are reporting perfectly-wonderful social lives. It disturbs me greatly.

What it tells me is that, in the school yards, there are so many obese kids that they are not considered "different" anymore.

For some of them, they actually have an easier time socially, because it has become more prevalent. You don't wish for any kid to have problems socially, but on a global level, it reflects the magnitude of the problem.

Do you think school meals play a big role in this?

I do think food in school play "a" role, but I don't know how big it is.

We know that the time children are spending in school is longer than any other activity they engage in, except for sleeping. So the messages they are getting at school is very important.

It's crucial for us to keep the pressure on the schools to make (themselves) a place where a healthy diet is more common. We all would like to see a reversal of the trend in terms of (the current reductions in) exercising in schools.

Decades ago, kids spent much more time exercising in schools that they do now.

Also, in some school systems, companies will offer to sponsor various activities in return for having their products sold in those schools. When schools have very tight budgets, I can imagine it's very hard to resist some of those (companies' offers).

Diabetes is highly prevalent among Latinos. Why do you think they are more prone to contracting the disease than the white population?

I am not an expert on diabetes. I am aware that there's a very strong genetic component to all types of diabetes. And the experience of the last couple of decades has taught us there's a strong a strong input of environment as it manifests through obesity.

So both of them [genetics and environmental input] contribute to that reality.

How has politics affected services for children locally?

Fortunately, in Massachusetts I think those effects are less for children than they are for adults.

Because the state (of Massachusetts) funds a program called Medical Security Plan, which is more than 10 years old, even undocumented children have health insurance.

And Massachusetts has, through the years, made that program easier to be accessed. There is a single application process now that puts people through MassHealth (the state's health insurance for low-income families), and if they don't qualify, other options will be considered.

This state has a really low number of uninsured kids; I guess it's less than 5 percent.

What has been the impact of health reform in Massachusetts for pediatrics?

It really doesn't impact pediatrics. Children were taken care of before the reform was approved. So the good news is that the treatment of kids is guaranteed in Massachusetts.

source: EthnicNewz.org

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