Sep. 6--Among the litter of modern American society -- all the candy wrappers, fast food bags, suburban sprawl, TV addictions -- lies a harsh truth about childhood obesity.
This might be the first generation of American children to be less healthy than their parents.
In the course of a few ravenous decades, children have come to dwarf the size of their parents at the same age.
The numbers are staggering, the rate of change stunning:
--More than a third of North Carolina's children are overweight or obese.
--In Guilford County, 44 percent of elementary students are overweight , according to a group working to combat obesity.
--The average 10-year-old in the United States weighs 10 pounds more than the average child in the 1960s , according to the Centers for Disease Control. And that translates into adult obesity: The average adult now weighs roughly 25 pounds more than his or her 1960s counterpart.
--Over the past two decades, the obesity rate for children has doubled, according to the American Academy of Pediatrics. For adolescents, the picture is worse: More than three times as many are now obese.
The causes are many: The suburban lifestyle, in which driving is king and walking is unpleasant. An ocean of subsidized calories that has made unhealthful foods ever-cheaper and portion sizes inflated. A culture of inactivity, in which time spent sitting in front of a screen means less time riding bikes or climbing trees.
In the end, the wave of obesity threatens to exact a staggering toll in health care costs.
Some believe the country is producing a "lost generation" of children who will struggle with obesity their entire lives.
"We have children aged 10 who have the arteries of 40-year-old adults," said Leslie Armeniox , head of Get Healthy Guilford, a group formed to tackle the issue. "They're not going to outlive their parents."
The costs
Two decades ago, Marian Earls was a rookie pediatrician. Now she's a veteran, and she's stunned at the changes she has seen.
Obesity is one of the biggest issues in pediatrics. Children display problems she simply didn't encounter when she was starting out.
"We treat kids for hypertension," Earls said. "That's kind of mind-boggling to me. You think of these as adult problems, but these are things you have to deal with."
The sharp increase in obesity has led to a boom in the rate of specific diseases, according to the American Academy of Pediatrics: Glucose intolerance. Insulin resistance. Type 2 diabetes. High cholesterol. Sleep apnea. Asthma. Skin conditions. Menstrual abnormalities. Impaired balance.
Annual costs for treating obesity-related conditions in children more than tripled between 1979 and 1999.
Overweight children are much more likely to have weight issues as adults. Two-thirds of adults are now obese or overweight, a figure that costs the nation more than $100 billion annually in health care and other costs, according to the Trust for America's Health.
The wave of childhood obesity promises to lead to skyrocketing medical costs in the future, with one study suggesting related costs could total nearly $1 trillion annually by 2030 . This affects even those who are not overweight, who ultimately pay more in taxes and for health insurance.
But some of the most painful costs can't be measured in dollars. Overweight children often have problems with self-esteem. They are more likely to be bullied or picked on. Depression and eating disorders aren't uncommon.
"They get real sensitive about their bodies," Armeniox said. "Kids can be mean."
Dr. Joseph Skelton , who heads a program at Brenner Children's Hospital aimed at fighting childhood obesity, sees the evidence of that frequently in his program.
"They're picked on. They're made fun of. When you read the literature on that, it's very sad," he said. "It is still OK to make fun of the fat kid. They're not the hero. They're not the object of affection."
What we eat
Double-patty burgers with 1,000 calories. Sixty-four-ounce drinks.
The diet of the average American child has been supersized in recent decades. A hamburger, fries and drink combo contains hundreds more calories than it did a few decades ago.
Burned out and overworked, parents don't always have the energy to cook at home, and the options they choose are likely to be those that offer a caloric rush.
"The quality of kids' diets has just gone downhill," said Kelly Tyrey , a High Point nutritionist.
"I wish I could get parents to be better role models," she said. "You can't bring home a cheeseburger and fries and eat that and expect your kids to eat broccoli."
Temptation is everywhere. Fast food restaurants and convenience stores are like neon-lit Gardens of Eden, offering a bounty of empty calories.
Armeniox's group has been surveying convenience stories to see what options are available. Not surprisingly, Ruffles and Twinkies outweigh apples and bell peppers.
Even those that offer healthful choices are overwhelmingly stocked with quick calorie injectors.
"The rest of the store has doughnuts and 600-calorie coffees," Armeniox said.
Schools are no haven either.
Interiors are lit by the pale glow of vending machines offering quick jolts of sugars and fats.
Cynthia Sevier , the nutrition chief for Guilford County Schools, said the system is trying to make meals more healthful by using whole grains and offering healthful items such as carrots and celery.
However, many students make an end-run around the healthful choices, ordering a la carte items such as crackers and ice cream.
The problem is that schools have been tasked with two contradictory goals: provide good nutrition but keep costs down.
"If you offer fresh fruit and vegetables, that comes at a cost," Sevier said. "It is a real struggle."
Even some items that had been removed, such as cookies and ice cream, have been added back as a way to increase revenue.
School vending machines do have limits. They don't offer soft drinks or snacks in elementary schools and 75 percent of the snacks in middle and high schools must have no more than 200 calories.
Still, no one is arguing that they're products from these machines are healthful. But they are cash cows.
"The schools depend on those machines to generate additional dollars for operations," Sevier said.
She has gone to Raleigh to try to persuade the state to provide more money for better nutrition.
Right now, it just isn't there.
"We know that it is money up front now, but it will save lots of money in the long run," she said. "North Carolina's obesity keeps growing and growing and growing. Something's got to give."
How we live
The manicured lawns and gently curving streets of suburbia offer, on the surface, a healthful environment for children. But the reality is less positive.
For decades, suburbia has been designed around the automobile. Houses are placed far from stores. Mega-schools that serve huge areas sit along major roads that are unpleasant or downright risky to walk along.
Even in the act of getting physical activity, children don't simply walk to a neighborhood field -- they're chauffeured around in cars.
Combine that with the vegetative allure of sitting in front of a screen, and the numbers, again, are dismal.
Nearly two-thirds of children don't get enough physical activity, according to the Centers for Disease Control . Seventy percent don't attend physical education class daily. More than one-third watch TV more than three hours a day.
"The only thing that they spend more time doing is sitting," Armeniox said. "Sitting in front of a screen. Sitting in a car."
Lindsey Rava , a spokeswoman with the North Carolina Alliance for Athletics, Health, Physical Education, Recreation, and Dance, which has trained physical education teachers, said schools don't devote enough time to physical activity.
"A lot of times, PE is cut back to make room for academics," Rava said.
But she and others argue that physical activity is beneficial to learning.
In Guilford County schools, elementary and middle school students are required to participate in "moderate to vigorous" physical activity for 30 minutes a day.
A few years ago, Robin Lindsay, then working as a Greensboro physician's assistant, created an organization called Go Far, which trains Guilford students to run a 5K race and builds the training into the school curriculum.
"I wish they could just understand the connection between physical activity ... and your brain function in general," she said. "It makes you a better student."
A way out
Even those involved in efforts to combat childhood obesity pause when asked how optimistic they are about the future.
The problem is so pervasive and rooted in so many fundamental aspects of our lives that solutions seem elusive.
Awareness about the need for more physical activity is gaining momentum, as is knowledge about the hazards of junk food. Some have suggested offering financial incentives for losing weight.
Many say a solution must include national policy-level steps, such as taxing unhealthful food or ending farming subsides that create cheap calories.
Foods such as corn that go into many high-calorie products are heavily subsidized; fruits and many other vegetables are not.
But many of the answers must come from home.
For families, most advise taking simple, modest steps.
"I push, 'Let's get healthy,' not 'Let's get thin' or 'Let's get smaller,' " said Tyrey, the nutritionist.
Take things one step at a time. If you eat out three times a week, try one or two instead. Go to the farmers market. Instead of watching a movie, go out and play. Sit down and have meals together.
And when you do, "Please turn off the TV," Tyrey said.
Over time, the small steps can add up -- for an individual child and for a society.
"You try to create a culture," Armeniox said. "It may take some time. But if you don't start, you'll never get it."
She predicts it might take a decade to see progress.
But she's optimistic that the very group at risk -- kids -- can be the ones to lead.
"They're the ones who got us recycling," she said. "They're the ones who'll get us on the track to health. People can change.
"We just really need to wake up and really watch what we're doing to ourselves and each other."
Contact Jason Hardin at 373-7021 or jason.hardin@news-record.com
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