The Pica Perspective

How can this be?

I'm not a researcher. I don't claim to understand the inner workings of a research project. Nor do I understand how different studies looking at the same problem can produce vastly different results. And I really don't understand the result of this study, reported in an article titled "Physical inactivity doesn't cause childhood obesity."

Here is an excerpt from the article:

Metcalf et al. published their longitudinal study in the June 23, 2010 issue of Archives of Disease in Childhood saying fatness leads to physical inactivity, but inactivity does not necessarily lead to fatness.

In the study, the researchers followed 202 children of whom 25 percent were overweight or obese for 7 to 10 years. 

During the follow-up, the children were asked to wear Actigraph accelerometers for seven days a year to measure their physical activity.  The body weight of each child was measured annually using dual energy x ray absorptiometry.

The researchers found the body fat percentage was predictive of changes in physical activity over the following 3 years, but physical activity levels were not predictive of subsequent changes in body fat percentage over the same follow-up period.

They concluded "Physical inactivity appears to be the result of fatness rather than its cause. This reverse causality may explain why attempts to tackle childhood obesity by promoting physical activity have been largely unsuccessful."

The bold emphasis is mine. And I ask again: How can this be? If overweight results from an imbalance between energy in (calorie intake) and energy out (calories burned), how can one part of the equation have no significance? And why is it that when I (the physical activity specialist) finally tore myself away from the computer and began walking every day, I lost 35 pounds? I did nothing different on the energy-in side of the equation; I simply began making sure I burned some of the calories I'd consumed...

Thoughts?

The latest on the childhood obesity crisis

Two interesting reports have surfaced this week: one good news and the other good news if you care only about the children in this country...

Regarding the latter, it turns out that American children aren't the fattest in the world after all. According to a CBS News report, there are more children -- 44 and 45 percent, respectively -- in Spain and Italy who are overweight or obese. In this country "only" 41 percent of the children are overweight or obese.

There was a positive side to this story: According to the study cited, the incidence of childhood obesity is increasing more slowly in the U.S. than in most of the other countries.

The really good news is that there's evidence that the childhood obesity crisis is beginning to subside. Several recent studies reported that rates of overweight and obese children plateaued after rising rapidly since 1980, but now a first major study has detected a decline - of 4 percent - and it was in a national sample dominated by low-income blacks and Hispanics, the groups at highest risk and the least likely to make a change.

Maybe people are finally getting the message! We can hope...

Happy meals lawsuit

I'm no fan of McDonald's, and I certainly don't approve of the tactic of offering toys (particularly toys related to children's favorite movies and TV shows) as incentives to buy Happy Meals. But someone, somewhere has to draw the line at what is corporate America's responsibility and what responsibility belongs to parents.

This week the Los Angeles Times reported that "a public health watchdog group called on the fast food giant to remove the playthings from all its meal packages" and has written a letter of intent to sue if the toys are not removed. The Center for Science in the Public Interest said that the plastic promotions lure children into McDonald's restaurants where they are then likely to order food that is too high in calories, fat and salt.

"McDonald's is the stranger in the playground handing out candy to children," Stephen Gardner, litigation director for the advocacy group said in a statement. "McDonald's use of toys undercuts parental authority and exploits young children's developmental immaturity."

I'm sorry, but who's in charge here -- the children or the parents? Are the children driving themselves to McDonald's and then whipping out their wallets to pay for their Happy Meals?

I realize we're living in an age when parents hesitate (refuse to?) say "no" to their children, but where are their priorities? Are they more fearful of stifling their children's budding self-esteem than of feeding them food that is too high in calories, fat and salt? The former concern is a myth; the second, if ignored, a killer.

For more perspective on this, listen to experts on "When and How to Say 'NO' to Children!"

PE Meets Early Childhood

At the beginning of this week I was attending the annual convention of the American Alliance for Health, Physical Education, Recreation, and Dance (AAHPERD). I often attend this conference, but this year I was there specifically as a master trainer for Head Start Body Start: The National Center for Physical Development and Outdoor Play. HSBS is a collaboration between the American Association for Physical Activity and Recreation (AAPAR) and the National Association for Sport and Physical Education (NASPE) and is funded by a grant from the Administration for Children and Families. Its three main objectives are:

1. To inform and assist the Office of Head Start in setting national priorities and developing policies.
2. To provide resources, training, and technical assistance to Head Start and Early Head Start Centers.
3. To administer and support grants for construction or improvement of outdoor play spaces at Head Start Centers.

It was the second objective that took me to Indianapolis, the site of this year's convention. On Tuesday, the HSBS team was responsible for training the physical education professionals who've signed on to be PACs: physical activity consultants who provide training and assistance to Head Start grant recipients, supporting them through site visits and offering in-person coaching and training in providing physical activity and outdoor play.

I share all of this with you because, as more than one of my colleagues commented, it was a day long hoped-for but never really expected. It was a day when physical education and early childhood education came together!

If this doesn't seem all that unusual to you, let me assure you that it is! Physical education teachers know little about early childhood (their elementary methods courses do nothing to prepare them for the realities of very young children!). And early childhood professionals know little about physical education (their pre-service courses may include movement as part of a methods course that also includes art and music!). I can count on the fingers of one hand -- and still have a finger or two left over -- those of us who have chosen early childhood movement/physical education as a career. What I can't count are the number of white hairs on my head that have resulted from this career choice -- because there's been so little understanding of the importance of movement education in the early years.

So, it was extremely gratifying to see a room full of PE professionals receiving the information they'll need to offer their support to the Head Start community. To quote my colleague, Linda Carson, "I never thought that in my lifetime I'd see this day." We're both glad we did!

Families of Couch Potatoes

Following on the heels of my last post about the high cost of being a couch potato is a new study showing that "families rarely take part in physical activity as a family because of the demands of work, school and the different interests of family members."                          

Interestingly, the majority of parents reported that they consider family participation in physical activity to be important, and they identified its many benefits, including time spent together, parent-child communication, having fun, better mental health, weight control, and physical fitness. Still, most parents reported their families did little or no physical activity together as a family unit during the week, and any activities performed together were usually sedentary in nature.

Sorry, parents, but if you want your children to be physically active, you're going to have to lead by example. Your influence is considerable.

For example, research has shown that parents' inactivity may exert more influence on their children's behavior than being active does. That is, if a child sees mom or dad sitting in front of the TV during all their free time -- if he never sees his parents exercising or enjoying themselves as they do something physical -- the parents' actions (in this case inactions) will speak volumes. He'll simply follow suit. Even if his parents tell him how important it is to be physically active, he'll have no reason to believe them.

A Penn State study demonstrated that children do indeed follow the example their parents set for them. Their research, conducted over two years, established that 79% of the girls who became overweight from ages 5 to 7, with or without a genetic disposition to obesity, were from sedentary families.

On the other hand, an article in the Australian Journal of Nutrition and Dietetics reports that children with active mothers are twice as likely to be active as children with inactive mothers. Children with active fathers are three and a half times more likely to be active than children with inactive fathers. And when both parents are active, their children are six times more likely to be active!

Parents might find it difficult, at first, to set aside time for something they consider an "extra." But as evidenced by the results of the first study cited here, parents do realize physical activity is much more than an "extra."

To serve as role models, parents can plan parties, outings, and vacations around physical activity. Looking for something to do on a Saturday afternoon? Go to the roller-skating rink. Planning a vacation? How about a trip to the mountains, where you can hike and swim, rather than to an amusement park, where you'll stand in lines and then sit on rides? Will you be inviting dozens of your child's friends to a backyard birthday party? Why not set up play stations -- one with bubbles to chase, another with balloons to volley, and still anotehr with beanbags to balance -- where the children, divided into groups, play for a while and then rotate?

Additionally, parents can guy gifts related to physical activity, like roller skates, a croquet set, or hiking boots. If a child gets only computer games, videos, and other sedentary materials, she's getting the wrong impression.

Of course, parents can also "walk the walk." As a form of exercise, walking is almost perfect. It's an exercise just about everyone can do, regardless of fitness level. It doesn't require special skill, and you can do it at your own pace. There are no fees involved, and there's no equipment required. Also, it can be both practical (it can get you where you need to go) and pleasurable (you can take in the sights and have a heart-to-heart with your child), while also burning calories.

How about scheduling a family walk every evening after dinner? Do it before you've cleaned up the kitchen so you won't lose momentum. Then come back and clean up together. Housework burns calories, too. And if you put on a piece of moderate- to fast-paced music in the background, you'll probably burn even more calories keeping time with the rhythm.

The High Cost of Being a Couch Potato

My second day back in the office after spending the better part of eight days traipsing around the country making presentations. It was exhausting, but despite the fact that I'd rather these trips be spread out a bit more, I'm grateful to have had the chance to "spread the word" to audiences in New Jersey, Arizona, and West Virginia!

It surprises me how many people are still unaware of some of the horrifying statistics concerning today's children, and it occurs to me that I may not have shared them here. But even if I have, they're worth repeating!

Here's some of what I tell my audiences about children and their sedentary lifestyles:

• Studies show that 2- to 5-year-olds are watching 25-1/2 hours of TV per week (and of course there was the recent study that determined children age 8 and up are spending 7-1/2 hours/day with electronic media).
• 40% of 5- to 8-year-olds show at least one heart disease risk factor, including obesity, which is growing at a faster rate among children than among adults, and hypertension. (Should we be using the words "5-year-olds" and "hypertension" in the same sentence?!)
• The first signs of arteriosclerosis (that's hardening of the arteries!) are appearing at age 5. (Previously such risk factors weren't seen in individuals under the age of 30.)
• Six- to 10-year-olds are dying of sudden cardiopulmonary arrest.
• A Centers for Disease Control Study determined that American children born in the year 2000 face a one-in-three chance of developing Type 2 diabetes. (Type 2 diabetes used to be called "adult onset" because it was so rarely seen in children, but it became so prevalent that they had to change the name!)
• This may be the first generation of children not to outlive their parents.

Depressing, huh? But there's good news as well as bad. The bad news is that there are about 300,000 deaths a year in the United States alone due to low levels of activity and fitness. The good news is that they're due to low levels of activity and fitness!

There are a million problems in the world that we feel helpless to do anything about. But this doesn't have to be one of them! This is imminently "fixable." All we've got to do is make sure that children have the time, space, and opportunity to move! They'll do the rest themselves!

By the way, if you want to read a great piece on the importance of physical activity to "successful aging," check out this New York Times article.

Obesity starts early in life!

A study published in this month's journal Clinical Pediatrics indicates that the "tipping point" in obesity often occurs before a child reaches age 2 and sometimes as early as three months.

Lead researcher Dr. John Harrington, a pediatrician at Children's Hospital of The King's Daughters and an assistant professor at Eastern Virginia Medical School, found that participants in the study had started gaining weight in infancy at an average rate of .08 excess BMI units per month, or just under 1 BMI point per year. On average, this progression toward obesity began when the children were three months old. More than 50 percent of the children became overweight at or before they turned 2, while 90 percent did before reaching age 5.

What's to be done about it?

Dr. Harrington believes pediatricians will now have to act before medical complications arise. He added, "Getting parents and children to change habits that have already taken hold is a monumental challenge fraught with roadblocks and disappointments. This study indicates that we may need to discuss inappropriate weight gain early in infancy to affect meaningful changes in the current trend of obesity."

What's going on here? This goes well beyond the need for increased physical activity and smaller portion sizes.

Thoughts?

Michelle Obama proposes Let's Move

This week Michelle Obama introduced her initiative to help fight the childhood obesity crisis. She's calling it Let's Move, which, as you can imagine, resonates with me!

What doesn't make me happy are the comments of the naysayers who insist that "the government" has no right to intrude on this issue. That weight is a "personal issue."

I weighed in on the topic of responsibility in this blog back in May of 2008. I'd like to repeat a part of it here:

It would be wonderful to imagine that if everyone simply took personal responsibility for her or his own weight gain, we wouldn't have to spend $100 billion dealing with obesity. But David Satcher told us that this is "the most overweight, obese generation of children in our history." Exactly whose responsibility is that? Let's think about it.

Without even taking into consideration the $100,000 paid to schools by soft drink companies to fill our children's bodies with empty calories, there's still the issue of recess and physical education disappearing from the schools. Who's making the decisions to eliminate all physical activity from the school day (where children spend most of their waking hours) despite mounting evidence that children need to move -- for the health of both their bodies and their minds? Not the children. Given a choice, they'd happily decide to mix more movement into the day.

There's also the matter of loading children's days with activities that preclude exercising more. Given a choice -- and the opportunity -- children might well opt to spend more of their time running, jumping, and breathing hard. But they're not being allowed to "choose freely." Rather, adults are choosing for them.

Are the children responsible for the fact that 32% of 2- to 7-year-olds -- and 65% of 8- to 18-year-olds -- have TVs in their bedrooms? Is it their fault they're not born with self-limiting mechanisms -- and that too often parents have forgotten how to say no? If young children were able to set their own limits with regard to television viewing and computer and video use, they'd need parents only to provide food, clothing, and shelter.The problem is, once a child is obese because of all these adult-made decisions, the odds are pretty much stacked against him. Not only are behavior patterns, like eating and physical activity habits, established in childhood (educational psychologist Benjamin Bloom contended that 90% of an individual's habits and traits are set by age 12), but long-term studies have also shown that excess body fat tends to persist throughout childhood and into adulthood.

So whose responsibility is it? It's clear to me that we adults need help helping the children. And if Mrs. Obama is offering it, I say we gratefully accept!

To Spank or Not to Spank?

Were you spanked? I was. Parents never thought twice about it when I was a kid.

Did it have any ill effects? Who knows? Maybe I would have turned out differently had I not been spanked, but I'll never know that.

Mind you, I'm not in favor of smacking kids. And I certainly understand the argument that when we do so, we're teaching them that violence is okay. I also understand the point of view of Dr. Murray Straus of the University of New Hampshire, and others, whose research shows spanking has traumatizing effects. But Dr. Straus's research indicates that these traumatizing effects result in lower IQs, and that spanked children develop more slowly. Could that be true? Is that the case with an occasional pop on the bottom? Or does that result with repeated, furious spanking?

Dr. Marjorie Gunnoe's research has shown that spanking isn't so bad after all. She learned that those teenagers who'd been physically disciplined up until the age of 6 performed better in school, had an optimistic outlook on life, possessed a willingness to perform volunteer work, and were ambitious about attending college.

Do you think her research will provide fodder for spanking advocates?

I had a great discussion with both Murray and Marjorie, along with Amy McCready of Positive Parenting Solutions and Sara Behnke, parenting author and blogger. It's featured this week on the Parents Channel at the BAM Radio Network.

So, what do you think? To spank or not to spank? Do you spank??

This radio program was a surprise

When I decided to do a radio program on ADHD, my original plan was to look into whether the need for Ritalin was myth or reality. I still think that would be a great topic for a show, but it didn't turn out to be this one. Instead, as I interviewed Drs. Peter Breggin and Andrew Adesman, the discussion turned to whether or not ADHD was a real disorder.

This was a fascinating experience for me. I'd chosen Dr. Adesman as a guest for his more traditional approach and Dr. Breggin because he was anti-Ritalin. I tend to be far more nontraditional in my approach to medicine and health and expected to be fully on Dr. Breggin's side during this discussion. (As the radio host, I'm expected to maintain my objectivity, but that doesn't mean I don't have opinions!) But I was in for a surprise.

I certainly agreed with Dr. Breggin's claim that restrictive school environments often contribute to the problem of "overactive" children. And I of definitely of the opinion that ADHD is overdiagnosed. And while I was fascinated with Dr. Breggin's contention that ADHD is not even a real disorder, I was most surprised by his claim that it can be solved through proper discipline at home!

What do you think? Click here to listen, and then leave us a comment!