Helping Kids Grow Up Instead of Out : Health Professionals Are Developing Programs to Combat Childhood Obesity

His mother described it as “shoveling.”

Without thinking, her blond, curly-haired boy pushed chocolate sandwich cookies, macaroni and cheese and hot dogs into his mouth. And more and more, the other kids were starting to call 9-year-old Sam Berman “Fatty.”

At 4 feet, 2 inches tall, Sam was tipping the scales at 80 pounds, about 20 pounds too heavy. His weight placed him above the 95th percentile on standard height-and-weight charts, a measurement many pediatricians use to define childhood obesity.

“The shoveling, combined with the kinds of food, were turning a minor problem into a major one. It was bad for his self-esteem,” said Lucy Berman, Sam’s mother.

Sam Berman has an advantage not available to most overweight children. His family lives in Palo Alto, near Stanford University’s Children’s Hospital, where researchers are developing programs they hope will halt childhood obesity.

The Stanford effort, modeled after pioneering work at the University of Pittsburgh, seeks to change the life style of the entire family. An initial workup includes a psychological evaluation and charts eating habits and activity levels.

A Family Affair

“Proper diet is a family affair, and--especially for a youngster--support of all family members is crucial. Even if the rest of the family isn’t overweight, it’s just not good for anyone to eat an unhealthy diet,” said Lawrence D. Hammer, director of the Stanford-Children’s Ambulatory Care Center.

In four months, Sam has lost three pounds and grown an inch, a good start toward slowly normalizing his weight.

Although proud of his accomplishments, Sam acknowledges the regimen hasn’t been easy. Referring to his favorite cookies, ice cream and chocolate, he confides: “It is hard to know them and not to eat them.”

Health professionals are becoming alarmed by the growing numbers of Sams--and Samanthas.

An article published recently in the American Journal of Diseases of Children examined results of pinch tests measuring skin thickness and concluded that in the last 15 years, obesity in children between 6 and 11 years old increased a whopping 54%, with youngsters 12 to 17 experiencing a 39% rise, according to co-authors Dr. William Dietz, director of clinical nutrition at Boston’s New England Medical Center, and Steven Gortmaker, a sociologist at the Harvard School of Public Health.

Parents with overweight young children have few places to turn. In recent years, medical awareness of eating disorders in teen-age girls has resulted in a variety of responsible programs. However, these services aren’t readily available for younger children.

In January, Cedars-Sinai Medical Center inaugurated the Body Shop, a pediatric weight-control model for children 8 to 18.

‘Nothing Available’

“We surveyed the marketplace, and we found that except for other Body Shops in Torrance, Newport Beach and Palm Desert, there was nothing available for younger children,” said Nancy Muir, a registered dietitian who coordinates the effort.

Childhood obesity is a health hazard. “It causes heart disease, adult onset diabetes, orthopedic problems and a higher incidence of respiratory infections,” said Dr. Naomi Neufeld, a pediatric endocrinologist at Cedars-Sinai.

Interestingly, pediatric obesity is a relatively new field. Dietz of the New England School of Medicine believes that negative cultural stereotypes of fat people have resulted in limited research.

Societal changes have conspired to help children get fat. There was a time when children raced home from school to change clothes and go outside to play tag, ride bicycles and throw baseballs.

Unlike their counterparts of yesteryear, today’s young children may have as many as three hours of homework. And then there is television.

Working parents add to the equation. “Working parents are worried about safety. They want to know their children are safe indoors.

Overweight youngsters have long frustrated pediatricians. Dr. John Fricker, a pediatrician with Kaiser Permanente for 22 years and a clinical professor of pediatrics at UCLA, reports little success.

Although it is too soon for long-range studies, some researchers think progress can be made by intervening early in a child’s eating habits.

“We believe we can prevent all obesity if we get children before habits are deeply ingrained and before they have as much access to food,” said Leonard Epstein, a psychologist at the University of Pittsburgh’s School of Medicine.

His approach includes a low-fat high-carbohydrate diet, an exercise program and behavior modification to change habits that encourage obesity.

Five-year follow-ups of 8- to 12-year-olds participating in Epstein’s childhood weight-control program indicate that one-third no longer were obese and another one-third maintained weight losses.

Currently, Epstein accepts families with children as young as 2. Families participate for a minimum of six months, with two months of weekly meetings carefully charting food choices and exercise.

To help children become conscious of nutrition and avoid calorie-counting, he developed the so-called “traffic light diet”: green or GO, eat-as-much-as-you-want foods, such as vegetables; yellow or CAUTION, eat in moderate amounts, such as an apple, baked chicken or a bagel; and red or STOP, including doughnuts, fried chicken, lasagna, and ice cream. Participants are limited to four red foods per week.

At Stanford, staff members found the limit was too difficult for some children. “If we are too restrictive, children tend to sneak food, and we don’t want that,” Hammer said. He permits a more liberal two reds daily.

For Sam Berman, those reds are a constant battle. His dilemma is complicated by two thin younger brothers, Marc, 6, and Joel, 2, who are allowed to eat foods Sam cannot.

Handling Temptation

Although Stanford recommends not keeping sweets in the house, Sam’s mother disagrees. She fears that if denied their snacks, the younger boys will resent their older brother.

Full family support, however, would appear to maximize results. When Robin Telerant, 11, of Westwood, joined the Body Shop in January, her parents cleared the kitchen of anything tantalizing.

“It is very boring. There’s no more salami, cheese, cookies or chocolate,” said Robin’s father, Michael, with a laugh.

Robin is sensitive about revealing her weight. However, beginning the program in January at four feet tall, Robin lost four pounds in the initial 10-week period. Since then, while attending monthly follow-up meetings, she has dropped an additional four pounds.

Success however doesn’t come to everyone. Robin’s friend, who attended the Body Shop with her, has since regained the weight.

What most parents don’t realize is that eating habits begin as soon as infants begin eating solid foods.

“During the first year, and certainly during the toddler stage, it is up to the parents to determine and control the food choices,” said JoAnn Hattner, a registered dietitian at Stanford Medical Center and spokesperson for the American Dietetic Assn.

Epstein, who has been working with overweight children for many years, urges parents to be positive in trying to motivate youngsters.

“Never use scare tactics, such as ‘You’ll never get a boyfriend,’ or ‘You’ll never make the basketball team,’ ” he advised.

Once children begin trimming down, many begin feeling better about themselves.

In Sam Berman’s words, “I feel taller and I run better on the field. And people don’t call me fat so much.”