Childhood Obesity Goes Beyond Food And Exercise

While First Lady Michelle Obama has publicly pushed against childhood obesity, many families struggle with it privately. The Centers for Disease Control say obesity affects 17% of America's children. In this weekly parenting conversation, host Michel Martin explores how obesity affects children and their families. She speaks with Lois Freedman, whose six-year-old daughter struggles with obesity; Saquonte Wilkinson, a high school student battling obesity; Dr. Nizrat Mirza from the Children's National Medical Center; and Kavitha Cardoza, a WAMU reporter who has investigated obesity's effect on children in Washington.

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MICHEL MARTIN, host: I'm Michel Martin, and this is TELL ME MORE from NPR News.

They say it takes a village to raise a child, but maybe you just need a few moms in your corner. Every week, we check in with a diverse group of parents for their common sense and savvy parenting advice. Today, we have the latest in our occasional series on chronic health conditions that affect kids.

Today, we decided to talk about childhood obesity. First lady Michelle Obama has focused national attention on the issue with her White House garden and her Let's Move campaign. She's trying to encourage kids and their families to eat better and exercise more. And just last week, the Department of Agriculture dumped the old food pyramid. Everybody remembers that. And it's replaced the pyramid with something called My Plate. That's a circle-shaped graphic aimed at showing people how to put together healthy, balanced meals.

Now, it might seem strange to think of obesity as an issue for kids, but the numbers do not lie. One of three children in the U.S. is now overweight or obese, and many are facing serious health conditions as a result. And recently, reporter Kavitha Cardoza - she's a reporter from member station WAMU in Washington, D.C. - reported on all this. So we've called upon her to help us with this conversation. Welcome back, Kavitha. Thanks for joining us once again.

KAVITHA CARDOZA: Thank you for having me.

MARTIN: Also with us is Lois Freedman. She's a paralegal; she's a mom of two. Her 6-year-old daughter has been classified as obese. The entire family has made changes to help her get to a healthy weight. Welcome, Lois. Thank you for joining us.

LOIS FREEDMAN: Hi. Thank you.

MARTIN: Saquonte Wilkinson also joins us. He's a 17-year-old high school student. He's been working on losing weight, and he's here to tell us about that. Welcome to you, thank you for joining us.

SAQUONTE WILKINSON: Thank you.

MARTIN: And also with us, Nizrat Mirza. She's a pediatrician. She's the medical director for the IDEAL Clinic - which stands for improving diet, energy and activity for Life - at the Children's National Medical Center. She's here with us for some expert guidance. Dr. Mirza, thank you for joining us as well.

Dr. NIZRAT MIRZA: Thank you.

MARTIN: So Kavitha, I want to start with you. You did a five-part series. It was excellent. It was called "The Heavy Burden of Childhood Obesity," and you looked at the struggle several families are facing in trying to keep their families at a healthy weight. Are there some common threads among all the families that you profiled?

CARDOZA: I think that it's such an overwhelming task. It really isn't just about that one particular child, but it's about the entire family making lifestyle choices, whether it's the food they make. One family - Lois's family, in fact - they said when they sent their children to camp and summer's coming up, they thought, oh, lovely, their kids will be running around. Except they get treats; they get candy and chocolate. So it's like having to look at every aspect of your child's life to make sure they're not eating unhealthy.

MARTIN: Were there some threads, or some common through lines, in what's driving this obesity crisis? Because one of the things that was fascinating to me, in looking at your data, was just how quickly this seems to have happened. I mean, the incidents of obesity among very young children has tripled and quadrupled in certain age groups. Teenage boys are sort of skyrocketing. And Kavitha - then I'm going to, obviously, turn to you, Dr. Mirza - what are some of the factors driving this?

CARDOZA: Recess has been cut a lot. Kids are not exercising as much. Or they're not outdoors as much. There's a lot of video-game playing. They are just not getting out as much. And with food, a lot of the school lunches are very unhealthy. So they were not eating very healthy, either. And it's very easy to go to, say, a McDonald's and eat something unhealthy rather than a home-cooked meal.

MARTIN: Dr. Mirza, what would you want to add to this? I mean, is it shocking to the medical profession how quickly obesity has become an important health concern?

MIRZA: That's right. Since the early 1960s, we have noticed an increase. So in the 1960s, when it was 5 percent overweight and obese, now we see a third of the children are overweight or obese. And I know you mentioned a figure of 30 percent. But in certain groups, you have as high a prevalence as 59 percent of kids are either overweight or obese.

And as you know, it's mainly in the minority groups where we have very high prevalence. And we think there is definitely an underlying genetic predisposition, and then you have this double whammy of more sedentary lifestyle and higher calories.

MARTIN: Saquonte, I think it's a good time to turn to you. You're our token teenager.

(SOUNDBITE OF LAUGHTER)

MARTIN: Young guy here. Thanks for coming.

WILKINSON: Thank you.

MARTIN: You know, we always think about teenage boys as being like, the calorie burners of the universe - like the human oven, you know. That you're always running around doing stuff, playing football, playing sports. Has weight always been an issue for you or is this something that happened later, when you got into your teen years?

WILKINSON: Not really. Weight has always been an issue for me. But I really didn't see it as an issue when I was younger. I might have got teased by it or anything like that, but I really didn't care about other people. I just wanted to do what I liked.

MARTIN: What is the issue? Do you think part of it's diet or is it that you, instead of playing football, you might play a video game about football?

WILKINSON: To be honest with you, it's just in between. It's so much easier to just do something like go to McDonald's and get a sandwich, or then cook it and cook it over time, or just like stay in the house and play video games then go outside itself.

MARTIN: Mm-hmm. And could I - do you mind if I ask you this question? It's kind of a delicate question, but for some kids in some neighborhoods, their parents don't encourage them to go out because the streets are dangerous. Is that part of what's going on?

WILKINSON: That's kind of part of what's going on because it's so many parents that are scared for their child to go outside because you don't know what will happen for them - and that's me also. But my mother trust me enough to know that I know what situation to get out of, and what situation to stay in or anything like that. But I honestly don't see anything outside for me when it's time. But when I do, I go outside and play.

MARTIN: Lois, your situation is a little different in that - tell us a little bit about your daughter. She's your second child, and you fed her the same things as you fed your first child. But somehow or another, her weight became an issue. Could you talk a little bit about that?

FREEDMAN: Part of it is, I've always been a working mom. The kids both had the same caregiver. I think there was an added component in terms of dealing with two and three children at one point in my house, and it's always easier to just give the baby a bottle to make them be quiet. So I think just the family dynamic, it was easier to just give Rachel food and have her be quiet so the rest of the day could go on.

MARTIN: So you're saying with the first child, maybe he got more physical activity because there was only one child and, you know, the baby, she could run around with him. But then by number two, she was looking for an easy way out. And that must make you feel terrible because, of course - you know, Kavitha; you wrote about this in the report. And you say the first thing most people do is point at Mom and blame Mom.

CARDOZA: I mean, Michel, it was amazing. When I would tell people the story, the first thing - reaction I would get was, that's child abuse. Her child should be taken away from her. And I - so I asked Lois about it because they have such a loving family, and I wanted to show that. I mean, that reaction was so unfair.

MARTIN: Lois, tell us a little bit about your daughter, though. When you first became aware that this was a health issue, she was how old?

FREEDMAN: She was 2. I mean, it smacks you in your face when you have a 2-year-old and you're not wearing true-to-size clothing, and you keep having to go up a size and up a size. Or just even in a, you know, playdate setting, you know, going to another family and seeing their 2-year-old. It becomes obvious, at some point, that she's bigger. Went to the pediatrician and was told to follow a heart-smart diet. I mean, that's for 60-plus-year-old patients or, you know, people that truly have medical conditions. How do you equate that with, you know, two-kid, two-parent working family? So it just wasn't reconciling, and it was very hard to implement.

We did things we could think to - you know, make the switch to skim milk; and look at the cheeses, go to lower count cheeses; cut out juice; cut out soda; you know, try and eat home more as opposed to going to restaurants. But then that wasn't even enough.

MARTIN: And it's hard, too, because the things that, you know, adults can give up easily - I mean, cupcakes aren't a huge part of adult world. I mean, but cupcakes, birthday cake, pizza - that's a huge part of kid world.

FREEDMAN: Yeah.

MARTIN: And when you have to tell your child no, you can't have that, it just feels - you feel what? Like, kind of an outcast in a way and...

FREEDMAN: Well...

MARTIN: I did want to ask, if you don't mind, how it felt for people to be like, pointing the finger at you? If you could just describe what that was like.

FREEDMAN: Oh, it still happens.

MARTIN: What do people say to you? Do they say things to you?

FREEDMAN: Not so much in terms of now looking at her and her weight but more - now, we are the mean parents that won't let her have cake at the birthday party, or bringing an alternative. I think sometimes, we would get a lot less flack if it was an allergy. You know, you can say I'm going to bring my own cupcakes because, you know, we have nut free, gluten-free, you know, and they have the special table. But the pressure on me, and on her, gets to be, you know, very difficult sometimes. And so there's sometimes, you know, backlash from Rachel in the car on the way home. And she doesn't, you know, she doesn't really get it. I mean, she gets it but there's always the, why am I different?

MARTIN: Mm-hmm. If you're just joining us, I'm Michel Martin and this is TELL ME MORE from NPR News. We're having our weekly visit with the Moms, our parenting segment Moms plus one. Our teenage man, we appreciate him.

(SOUNDBITE OF LAUGHTER)

MARTIN: And we're talking about childhood obesity as part of our occasional series on chronic childhood conditions. We're visiting with Kavitha Cardoza, a reporter from member station WAMU in Washington, D.C., who recently did an extensive - and a terrific - report on this; Lois Freedman, mother of two; Saquonte Wilkinson, he's a 17-year-old who - a high school student who's addressing this issue; and pediatrician Dr. Nizrat Mirza.

Let's talk about - what are some of the solutions that people are employing to try to address this issue? And just to remind people, again, of the extent of the issue, the Centers for Disease Control estimates that 17 percent of children in the U.S., age 2 to 19, are obese. The percentages Dr. Mirza told us is higher in communities of color. Dr. Mirza, talk about what you're doing at the clinic to try to help people get a handle on this issue.

MIRZA: Our clinic, especially, is a referral clinic. But I would like to talk more about a pediatrician's clinic. I think it's very important for pediatricians - just like when Lois mentioned it, it shouldn't have been Lois talking to her pediatrician. It should have been her pediatrician seeing it early. And one of the statistics which we haven't mentioned is that obesity rates among infants and toddlers, it's 10 percent. That is a shocking number for people like us who are working in this area, because it starts early and it tracks on to become preschool obesity and then teenage obesity, and then adult obesity.

Oftentimes, we as pediatricians tend to be happy when a child is gaining weight and, in fact, we encourage the mother and say your child has doubled the weight, tripled the weight in two months. That should not be happening. You should be tripling the weight at one year. So you know, as a baby is born, you know, 8 pounds should be 21 pounds, 24 pounds at one year, not at three months. So curbing it early, so allowing the baby themselves to determine the satiety.

MARTIN: You mean letting the baby stop eating when she's finished.

MIRZA: Yes. Yes, when she's finished.

MARTIN: When she seems full.

MIRZA: Exactly.

MARTIN: You know, it's true because a lot of us grew up with this attitude of, you know, constant feeding, feeding, feeding because that's how you showed love.

MIRZA: Yes.

MARTIN: And you're saying everybody's got to change their mindset on this, you know.

MIRZA: And there's also the societal pressure of a chubby baby is healthy.

MARTIN: Right.

MIRZA: Everybody loves a chubby baby. You know, we did some focus group with some Latino communities. They said when we have a baby who's not chubby, they say oh, that poor thing; it's so thin and unhealthy.

MARTIN: And you're also doing a lot of work intensive work at your clinic with the whole family. Talk a little bit about that.

MIRZA: That is true. So it's very important for the whole family to make a change. It's not right to pick on one child. You cannot give Johnny a cake and just give me whole-wheat bread, you know. So healthy eating should be for everybody, including the parents. The parents are the role model. The parents have to be eating healthy, too. And the same thing with physical activity. The parent cannot sit on the couch watching TV and say, you go outside and play. So you have to kind of do it together.

MARTIN: Lois, what are some of the things that you've done? You already started to tell us about this, that you've already implemented this kind of not using food as a reward thing.

FREEDMAN: Yes.

MARTIN: Really helping the child make some choices and say OK, you're going to have how often do you have dessert, by the way? Once a week? Only on the weekends? How do you manage that?

FREEDMAN: We've redefined dessert in our house. Dessert can be a fruit. So there's always dessert. It's just not the conventional ice cream, water ices, cake. Or dessert is something that is offered if everything on the plate's been eaten or at least attempted to been - eat. And, you know, oftentimes it's just because we don't want the fruit to go bad so we'll...

(SOUNDBITE OF LAUGHTER)

MARTIN: What's been - what about for you? Has it, what's been the hardest thing for you?

FREEDMAN: Implementing the lifestyle change. I mean, it's so easy to come home after a day of work and, you know, sitting on the Metro and just wanting to call up Papa John's and have a pizza because I'm too tired. And my husband does a lot of the cooking. It's hard work.

MARTIN: Saquonte, what about you? When did you decide that you wanted to embrace this issue and take on your weight? And bravo you for doing that, by the way, and also for being willing to talk about it. Go ahead.

WILKINSON: Well, to be honest with you, I've been obese all my life - when I was a little kid - and I used to get teased by - people used to call me names, such and such, and I used to cry about it a lot. So when I got older, I learned to deal with it. Just turn the other cheek. If somebody called me fat, I'd say oh, I love eating. Or I'd say, I enjoy my weight - or anything like that. Anytime somebody insulted me, I end up just turning another cheek to and just smiling.

MARTIN: Mm-hmm.

WILKINSON: And when I got older, I just said to myself I was just tired of being big, and I'm kind of tired of hearing people saying something or saying oh, my God he - look how big he is, or anything like that - or afraid to take off my shirt at a water park or anything like that because of my weight. So I said I won't - I technically don't have to be like, super skinny, just enough to lose weight to the point that I'm happy with myself.

MARTIN: And what are some of the things you're doing?

WILKINSON: I'm starting to walk more. I say to myself, I'd rather walk than catch the bus. If I have some leftover money, I might go get a salad instead of a burger or something, or I start cooking my own food instead of just trying to order out or something. I admit to myself, I do order out whenever - like, once in a while. But if I have the time, or if there's something in the fridge then I'll make something, I'll make it.

MARTIN: What's your goal?

WILKINSON: My goal is just to be like, a semi-big person.

(SOUNDBITE OF LAUGHTER)

WILKINSON: Just like be big but just not like how - like, be fat-big.

MARTIN: OK. All right. Well, good luck with that. Kavitha, final thoughts from you. Give us a final thought from you. Where did you - where did this report leave you? I mean, was this a revelation for you when you decided to dig into this?

CARDOZA: Absolutely. One of the biggest takeaways, Michel, is if we are going to deal with this issue, there has to be practical information out there. And I found that that was totally lacking. For example, there's a lot of emphasis on calorie labeling. Well, what we found was, a lot of people did not understand what those calories meant. If you give them a calorie number, but they don't know how long it takes to burn off that amount of calories - if you say it takes an hour of running to burn off that soda, people were making a better choice. So I think we need a translation in the information.

One of the pieces of information I got the most feedback on is, a doctor I interviewed said if you look at the label of an item where it says sugar, five grams is equal, approximately, to one teaspoon of sugar. So people started saying oh, my gosh, we never knew that and now, we make choices looking at the sugar. So there's information, but it's not being translated into something easily understandable.

MARTIN: Kavitha Cardoza is a reporter for member station WAMU in Washington, D.C. If you'd like to hear her series in its entirety - and we hope you will - it's called "The Heavy Burden of Childhood Obesity" We'll link to it on our website. Go to npr.org, click on the Programs tab, and then on TELL ME MORE. Also with us, Saquonte Wilkinson. He's a high school student here in Washington, D.C.; Lois Freedman, she's a mom of two; and Dr. Nizrat Mirza, she's a pediatrician and the medial director for IDEAL Clinic. That's a clinic that addresses childhood health and family health issues at Children's National Medical Center. They were all here with us in our Washington, D.C., studio. I thank you all so much for joining us.

CARDOZA: Thank you.

MIRZA: Thank you.

FREEDMAN: Thank you.

WILKINSON: Thank you.

(SOUNDBITE OF MUSIC)

MARTIN: And that's our program for today. I'm Michel Martin, and this is TELL ME MORE from NPR News. Let's talk more tomorrow.

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