How to fight and beat childhood obesity
The best way to solve any problem is to eliminate its cause. In the case of childhood obesity, "the causes are many and varied," admits Dr. Robert H. Lustig, a pediatric endocrinologist at UCSF and director of the Weight Assessment for Teen and Child Health (WATCH) Clinic. "The main contributors to childhood obesity are overnutrition and physical inactivity; two conditions that promote excess insulin."
Lustig says the majority of today's calories come from highly processed convenience foods and soft drinks. Many fast-food meals are super-sized, and fewer children eat home-cooked meals with their families.
"Everybody knows fast food is bad for us, due to the refined carbohydrates and sugars and lack of fiber. But the companies producing these foods and drinks are making too much money to alter their composition or to stop making them," explains Lustig.
Overnutrition is further compounded by today's sedentary lifestyles. For example, children rely on transportation instead of walking or riding their bikes. Due to budget cuts, many schools have cut back on physical education during the school day and sports activities afterwards. While suburban neighborhoods seem to discourage outdoor play with their lack of sidewalks, many inner cities are considered too unsafe for outdoor play. Furthermore, among all socio-economic groups, children's favorite activities require sitting in front of a screen – be it a TV, computer, video game monitor or cellphone.
Lustig says obesity is a disease of civilization, in which food processing and urban planning has led to medical changes. "To solve the obesity epidemic, we have to change the entire landscape of food and activity and what we think is important in this country," he says. "We can't simply tell people to eat less and exercise more. That obviously doesn't work. Obesity must be considered a medical problem."
Lustig believes fighting obesity has to start at the grassroots level, beginning with education. He says we have to act on many fronts: kids, families, neighborhoods, schools, the food industry and the government.
"We have to change public policy in terms of how we care for the obese, how physicians are reimbursed and, ultimately, how food and exercise are marketed in this country. Obesity must be treated as a serious public health issue, or in 30 years there won't be any money in the till for anything else," he says.
Until these changes take place, Lustig continues working to promote his message through the media and within the WATCH Clinic. He works closely with Andrea Garber, a nutritionist and coordinator of the WATCH Clinic. Together they help children and teens lose weight by adhering to three basic rules:
Eliminate the biochemical triggers of obesity
As explained in Childhood obesity: What's really triggering this epidemic? Lustig says, "We have to eat less refined starch and sugar and more fiber."
One sugar to avoid is high-fructose corn syrup, which is in nearly all processed foods and drinks. In addition, the food industry has removed most of the fiber from our foods so they can be frozen, cooked quickly, shipped easily and have longer shelf lives.
Lustig wants parents to help their children reduce insulin levels. Insulin levels increase when refined carbohydrates and sugars are consumed. "As long as insulin levels are elevated, your child is going to gain weight. When blood sugar levels go up, insulin goes up and shunts the sugar to fat. That's its job," explains Lustig.
"Fiber also helps keep insulin levels down," adds Garber. "It slows sugar absorption from the gut into the bloodstream and lowers insulin response." Studies show that kids who eat less are less hungry at the next meal."
The best way to get insulin levels down is not to eliminate all carbohydrates and sugars, but rather to switch to low-energy density, high-fiber carbohydrates. Examples of brown food are: steel-cut or rolled oatmeal (not the instant kind), brown rice, whole grain bread, beans and other legumes. Lustig advises his patients to stay away from white food, including: refined carbohydrates such as white bread, white rice and white pasta, which have had their fiber removed.
While it is surprising to many, Garber also advises people to avoid drinking juice because it contains too much sugar. "While an orange has about 70 calories and is a good source of fiber, a 12-ounce bottle of orange juice has about 165 calories and no fiber. The juice is nature's way of getting you to eat the fiber," says Garber and Lustig. "So even though a child may not be drinking soda, too much juice can have the same effect and cause a child to pack on dangerous amounts of weight."
Lustig also advises parents to help their children avoid second portions. All too often a child will quickly eat a full plate of food and immediately ask for more. And parents will give their child a second full plate.
"My advice is to postpone the second helping for 20 minutes," says Lustig. "That's because the body has a 'satiety' hormone in the intestine, which tells the brain the body is full. However, the food has to pass through 22 feet of intestine before it generates that hormonal signal, which takes about 20 minutes. If the child is still hungry after 20 minutes, give him more food. But in most cases, the child will have moved on to another activity."
Get active
Exercise is also very helpful in fighting obesity because it helps bring down insulin levels. However, the exercise must be done on a regular basis to be most beneficial. In general, it's most helpful when parents not only encourage an active lifestyle, but also participate in activities with their children.
Lustig adds that exercise is the single best way to bring down cortisol, which is a stress hormone which also raises insulin and promotes obesity.
Use medicine when necessary
Lustig strongly recommends lifestyle interventions as the best way to fight obesity. "It is the cheapest, easiest and safest way of altering hormones."
"However, in some cases, we recommend medicine to help make insulin work better, which helps the patient lose weight," says Lustig.
"Eliminating the biochemical triggers of obesity is the single best way to combat childhood obesity successfully," adds Lustig. "This just takes us back to where we used to be before big food changed our diet for us."
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