Working with an obese child

While childhood obesity is a serious crisis across the nation, I was truly stunned by an action that removed an 8-year-old child from his home and into foster care simply because he was obese.

ABC News out of Cleveland, Ohio reported that this boy was removed from his mother after officials claimed she “did not do enough” to help him lose weight. According to the news report, the family had been working with the child, including enrolling him in healthy children’s programs, but the weight hadn’t come off. Instead of working with the family on interventions, the state opted to pull the child from the family.

While the state strongly believed it could do better in assisting the child with the weight problem, removing a child from his or her rightful parents can often create other problems such as emotional and mental distress. In the same ABC News report, another parent had come forward with news that her child had once been taken away because of obesity, but the state’s plan failed to help the child lose weight.  Not only did the child return to the family still in an obese state, he likely suffered emotional and mental problems thanks to the state’s removal process. In this case, the state’s action seemingly created more grief for the entire family.

Child removal is generally performed when there is suspected or known abuse of a child. The fourth amendment states that citizens have the right to be secure in their persons, houses … but upon probable cause, the persons or things could be seized. In the case of the Cleveland child, I don’t see that enough probable cause warranted removal. I just don’t understand why the state or local children’s health agencies couldn’t have stepped in with interventions and suggestions rather than pull the child from their rightful parents.

Research has shown that numerous interventions can be helpful for obese children and teens, but almost all of them involve family and community assistance while the child remains with their family. One of the key ingredients to understanding obesity is to educate the parents. Parents often struggle from obesity themselves which affects their ability to talk with their child in a non-judgmental way regarding losing weight. This is where agencies and health professionals could step in.

In Meadville, there are several resources available to help you and your family learn about healthy weight. These include the Meadville Family YMCA and various fitness centers with qualified trainers, the WIC Program, your personal care physician, your child’s pediatrician, Weight Watchers programs that include educational components, and independent dietitians such as Rust Nutrition. You can find these places listed in the phone book. In addition, the internet can provide a plethora of information on dealing with obesity in your family. Working with an obese child is an emotionally and physically taxing experience. You need to be prepared yourself in order to be successful.

Exercise Prescription on the Net is a resource set up mainly for exercise professionals, yet it provides a basic checklist to help you engage your children in healthy habits.

1.       Educate yourself on obesity, and consider working with professionals who may better connect with your child on the issue.

2.       Choose a private place to speak with your child about obesity and weight concerns.

3.       Never associate the child’s weight with acceptance or approval. You do not want your child thinking that you will love them more if they lose weight.

4.       Discuss feelings and body image, being sensitive that their weight may be creating low self-esteem. A professional may be your best solution in helping your child with this issue.

5.       Emphasize healthy habits rather than weight loss, such as increasing activities or eating more vegetables at dinnertime.

6.       Work with a healthcare provider or dietitian on meal plans and snacks. You should not approach this as a diet, but should consider it a lifelong habit in which the entire family participates.

7.       Monitor eating and activity and stock up on healthy foods. Consider removing poor nutritional choices such as sodas, chips and candy from the home.

8.       Eat meals together as a family. The child needs to see you consume healthy foods as a positive influence and role model.

9.       Do not reward positive behaviors with food; and likewise, do not punish with lack of food. Food is a nutrient, not a reward or punishment system. Children will associate food with good or bad behaviors and eventually treat them likewise, which will promote eating disorders. Use stickers, praise or other favorite activities for rewards and try withholding favorite activities such as internet use as punishments.

10.   Do not “make” your child exercise. You should adopt language like “Let’s play” or “Let’s go …” At least 60 minutes of daily play is recommended for children, and the best way to motivate is by doing it with them.

Interventions that promote healthy behaviors should start early, even if you or your child doesn’t seem to have any signs of being overweight.

References

Exercise Prescription on the Net. (2011). Childhood and teenage obesity. Intervention strategies. Retrieved November 30, 2011 from http://www.exrx.net/FatLoss/ChildObesityIntervention.html.

Newcomb, A. (2011). Obese third grader taken from mom, placed in foster care. Retrieved November 30, 2011 from http://news.yahoo.com/obese-third-grader-taken-mom-placed-foster-care-201731761.html.

The Rutherford Institute. (2001). Social services investigations: the removal of children from the home. Retrieved November 30, 2011 from http://familyrightsassociation.com/bin/white_papers-articles/investigations.html.

Don't Blame Ronald for your Poor Health Choices

A recent report in The Wall Street Journal revealed that more than 550 health professionals and organizations have signed a letter to McDonald’s Corporation asking them to quit marketing their Happy Meals to children and to retire their mascot, Ronald McDonald. Supposedly this letter was printed in six metropolitan newspapers across the country on Wednesday, May 18.

While I am a public health professional and concerned about the high obesity rates – especially among children, I question whether this is a suitable approach to building a healthier nation. Is it really McDonald’s responsibility to feed our children low-fat, low-sodium, low-sugar, and low-calorie foods? Whatever happened to personal responsibility? Whatever happened to parenting that involves appropriately feeding their children healthy and nutritious foods? Whatever happened to families teaching our children that food fuels our bodies and that it is important to select healthy options?

While it is truly not their responsibility, McDonald’s Corporation has gone above and beyond to offer healthy alternatives to the greasy hamburger and overly salted French fries commonly ordered at the chain. In McDonald’s defense of marketing to children, let’s take a look at the child’s menu options. The traditional “Happy Meal” comes with one of the following main protein sources: hamburger, cheeseburger or chicken nuggets. After the main dish selection, the options become rather interesting: you have a choice of fries or apple slices. Parents who are mindful of their child’s health will ensure they select the apple slices (or order it for them). Furthermore, the drink is not a sugary soda, but either low-fat milk or apple juice. Total caloric intake: 250 for the hamburger, 100 for the milk, and 105 calories for the apple w/dip for a total of 455 calories (take off 70 calories if no dip is consumed with the apples). In fact, a nonscientific survey of several of my peers who have young children indicated that their child prefers the healthy alternatives at McDonald’s. Perhaps my friends understand the concept of personal responsibility and instilling healthy behaviors to their children.

In addition to the Happy Meal, McDonald’s has many other healthy alternatives for adults as well. For example, they now offer oatmeal, a food choice that wouldn’t have been seen in the store even five years ago. They also have some of the best salads that fast-food chains offer, including the Asian chicken salad, grilled chicken salad, and side salad. Yes, many of the salads are topped with fried chicken, which is not the healthiest selection; however, my point is that there are options besides ordering high-fat foods. Furthermore, they even have a snack-size fruit and walnut salad.

At McDonald’s competition – Burger King, Wendy’s and Taco Bell – there are few, if any, options for children. Burger King does have apple slices, but doesn’t market them as part of their kid’s meals like McDonald’s has been doing. Burger King also only serves 3 different salads, unlike McDonald’s selection of 10. Wendy’s also has a limited menu for the health-conscious diner. Included on what they coin as their nutritious offerings are apple slices, four salad choices, a plain baked potato and a small chili. Taco Bell has no low-fat food choices as all of their salads are served in deep-fried taco shells, and they offer no fruit option. Probably the healthiest thing on the menu is the salsa...if eaten by itself!

The list of fast food restaurants seems endless, but the choice to dine at any of them comes down to personal responsibility. Although I seem to be defending it with great force in this column, I confess that I’m not a huge fan of McDonald’s and generally do not eat there...but that’s my personal choice. If I were taken to there, though, I know I would at least be able to find something relatively low-fat to eat.

According to the Wall Street Journal article I mentioned earlier, fast food restaurants as well as other food makers are routinely attacked for marketing to children. In response, federal standards have been posted by the Federal Trade Commission, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the U.S. Department of Agriculture. These guidelines suggest (not require) that marketers push their healthier items to limit children’s attraction to high-fat, high-sodium, high-sugar, and high-caloric foods.

Still, is it really the government’s responsibility to tell your child what to eat? I don’t think so. It comes down to parents teaching their children, it comes down to personal responsibility for your own health and the health of your family. If you choose to go to McDonald’s, that’s fine. Eat what you wish...but don’t blame the restaurant for your poor health because no one held a gun to your head for you to eat a Quarter Pounder with cheese for a whopping 740 calories, 42 grams of fat, and 1380 mg of sodium topped off with a side of fries (380 calories) and chased down by a large cola (210 calories).

References:

Burger King. (2011). Retrieved June 20, 2011 from http://www.bk.com.

Jargon, J. (2011). McDonald’s under pressure to fire Ronald. Retrieved June 20, 2011 from http://online.wsj.com/article/SB10001424052748703509104576329610340358394.html

McDonald’s Corporation. (2011). Retrieved June 20, 2011 from http://www.mcdonalds.com/us/en/home.html

Taco Bell. (2011). Retrieved June 20, 2011 from http://www.tacobell.com/.

Measles on the Rise

Pennsylvania is one of four states that have reported outbreaks of measles so far for 2011. So far, the state has seen six cases, which is high considering that a simple vaccination can ward off the disease.

Other states with outbreaks are Florida with five cases, Utah with nine cases, and Minnesota with 21 cases. Almost all of them have been linked to some sort of international tie, leading researchers to believe that the disease is traveling across the ocean and infiltrating the United States.

According to the Centers for Disease Control and Prevention, 89 cases of measles have been reported in the United States between January and April, which is exceptionally high. Typically the nation experiences about 50 total cases of measles annually…the number reported within the first four months of the current year is almost double the norm. CDC officials believe that this may be an indication of the worst measles outbreak in any single year in more than a decade.

Prior to this year, the worst year for a nationwide measles outbreak was 2008 when 140 cases were reported. Right now, the number of reported cases is more than halfway to this number with another eight months to go in 2011.

Measles is a respiratory disease that is caused by a virus. It normally grows in cells that line the back of the throat and lungs. Symptoms of measles generally start seven to 10 days after contracting the virus and include fever, runny nose, cough and sore throat. Two to three days later, white spots will appear inside the mouth. Eventually, a rash will appear on the face and spread to the rest of the body rather rapidly. Although it’s practically eradicated around the United States, measles still kills more than 200,000 people worldwide. This is mainly because the vaccination is more readily here than in other countries. The recent outbreaks indicate that people are not vaccinated against measles.

Although the vaccine is available in the United States, so many people choose not to obtain it, thus putting themselves at risk for the disease. This is the reason we are now experiencing an influx of measles cases in several states. If unvaccinated, you are placing yourself at a great risk of contracting the disease, which is transmitted through the air via coughing or sneezing – anything that can spread a virus, much like the common cold.

It’s critical to protect you and your family against measles – and it’s one of the easiest things you can do. To prevent measles, the CDC recommends that all children be vaccinated with the measles, mumps and rubella (MMR) vaccine. Two doses are needed for complete protection. Children should be given the first dose at ages 12-15 months. The second dose can be given a month later, but is often given before the child starts kindergarten, sometime between ages 4 and 6. Adults can also be given the 2-dose vaccine or a 1-dose vaccination. The CDC states that the 1-dose vaccination is mainly limited to people ages 50 or older.

If you are considering the MMR vaccine for you or your children, talk with your primary care physician. They have the background information on your health and well-being and will provide the best guidance for your overall health and protection. With a measles outbreak pending, it would be to your advantage to be vaccinated.

References

Associated Press. (2011). US on track for most measles cases in a decade. Retrieved May 8, 2011, from http://www.google.com/hostednews/ap/article/ALeqM5iZZE3c91FXNJHn1CGMiv7LmIk1oA?docId=b0bfb5447beb4ee395eceadabaa13e93.

Centers for Disease Control and Prevention. (2011). Recommended adult immunization schedule – United States, 2011. Retrieved May 8, 2011, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6004a10.htm?s_cid=mm6004a10_w.

Centers for Disease Control and Prevention. (2011). Vaccines and preventable diseases. Measles vaccination. Retrieved May 8, 2011, from http://www.cdc.gov/vaccines/vpd-vac/measles/default.htm#notvacc.

Build Self-Esteem; Prevent Suicide Among Children

Low self-esteem, bullying, depression, and feelings of helplessness have led to increased suicides, especially among youth. In the United States, suicide remains the fifth leading cause of death among children ages 5 to 14, but it is the third among young adults ages 15-24. From a public health standpoint, suicide as well as attempted suicide is a serious condition that is fully preventable. Unfortunately, attempted suicide often leaves the individual alive yet severely depressed or in poor mental and physical conditions that cost society hundreds of dollars

Of those with the highest prevalence of suicide and depression prevalence, Pennsylvania is ranked 33rd, which is in the lower half of the country. This equates to 11.1 suicides per 100,000 people annually. According to the 2010 U.S. Census information, the state with the highest number suicides is Alaska. Overall, the suicide rates in the United States are low by comparison to the world. The former Soviet Union states continue to hold the record for the highest level of suicides. Belarus, which had a rate of 36.8 suicides per 100,000 people, has the highest number of suicides in the world followed closely by Lithuania. Korea, Japan, Switzerland, and France are also among the top 20 with the highest suicide rates. What’s going on? Why are worldwide suicides apparently common and popular among the younger generations?

Although most studies on suicide blame the decline in mental health services for the high rates, I would point toward learned helplessness and a worldwide display of apathy toward others that may be at greater fault for creating the indifferences noted around the globe. Suicide has been seen as a cry for help – but by the time suicide occurs, it’s too late to actually provide that help. One study from the United Kingdom suggests that family, friends, and neighbors need to be more concerned with each other, which had been the norm decades ago. I wholeheartedly agree. However, the current argument is that mental health issues need to be dealt with on a professional level, a public health level that seems to take family and friends out of the picture (for the most part). To reduce emotional distress that could lead to suicide, we can’t remove ourselves from the picture. We actually need to invest more in the situation – especially when we’re dealing with children and youth. Friends and family in particular are the ones who can detect problems long before professional help is sought. Why do we often fail to intervene? It’s probably because we don’t understand the problem, and hence shy away from it – hoping that it will just go away. Wrong approach.

The World Health Organization has strongly suggested a public awareness campaign – geared to assist with recognizing suicidal behaviors, especially among children, to help people know that they can be part of the solution. I believe we – as a society – need to understand the signs of declining mental health and be able to step in to avert a suicide. Strengthening positive behaviors and thoughts rather than reducing negative actions and mental processes seems to be one way that could improve children’s self-assessments. By focusing on the positive, children are able to gain increased self-esteem that wards off suicide or other self-destructive behaviors.

Signs of suicide or low self-esteem include feelings of helplessness, lack of interest in activities, seclusion from others, crying, and poor school work (or work). If your child, your neighbor, or your friend exhibits such behaviors, it may be time to talk with them…about anything! Simply spending time with them (i.e. take them for ice cream, go to the park, take a walk) may create a more positive social environment that will increase his or her self esteem. Research shows that focusing on the positive may be one of the best ways to build a child’s self esteem, rather than pushing to find out what is bothering the youngster. In some cases, the child might not understand or know why they are feeling so sad. Working to accentuate the positive may be the ticket to put a smile back on their face.

References

Cutcliffe, J. R., & Stevenson, C. (2008). Never the twain? Reconciling national suicide prevention strategies with the practice, educational, and policy needs of mental health nurses (part one). International Journal of Mental Health Nursing, 17, 341-350.

Insider Monkey. (2011). Population density by state and suicide rates. Retrieved April 28, 2011, from http://www.insidermonkey.com/blog/tag/suicide-rates-by-state/.

National Institute of Mental Health. (2010). Suicide in the U.S.: Statistics and Prevention. Retrieved April 28, 2011, from http://www.mentalhealth.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml#intro.

Owens, C., Owen, G., Lambert, H., Donovan, J., Belam, J., Rapport, F., & Lloyd, K. (2009). Public involvement in suicide prevention: understanding and strengthening lay responses to distress. BMC Public Health, 9, 308-317.

Thomson Healthcare. (2011). National Center for Health Statistics and Bureau of Census data. Retrieved April 28, 2011 from  http://www.usatoday.com/news/health/2007-11-28-depression-suicide-numbers_N.htm#.