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Scary news about childhood obesity--is it time for drastic measures?

Posted by Dr. Claire McCarthy September 27, 2012 11:26 AM

Obesity is even worse for kids than we thought.

That's the conclusion of a study just published in the British Medical Journal that looked at a whole bunch of studies on kids and risk for cardiovascular disease (disease of the heart and blood vessels). When they looked closely at the numbers, the researchers were alarmed.

This is saying something, because we were already worried. Being overweight or obese (obese is defined as having a body mass index at the 95th percentile or higher--to find out where your child is, use the BMI calculator on the CDC website) doubles or triples the risk of high blood pressure, and we are seeing atherosclerosis ("hardening of the arteries") as early as nine.

We need to be thinking more carefully about when we start worrying about kids, they said. We may just need to be worrying sooner--and doing more work for prevention, because the implications for the future health of overweight and obese kids are, well, bad. Here's what the researchers said:

"We found that overweight and obesity have a significant effect on blood pressure, lipids, insulin levels and resistance, and left ventricular mass. This effect on risk parameters for cardiovascular disease is greatest in obese children and the implications for their future health may be greater than has been previously suggested."

We may need more aggressive and drastic measures.

A little less than a year ago, Georgia came out with some anti-obesity ads that featured overweight children, with taglines like "It's hard to be a little girl when you aren't". The idea was to "wake people up", and it certainly got people talking--but it felt uncomfortable to a lot of us to shame kids when, actually, the biggest risk factor for childhood obesity is having an obese parent. Did you know that? According to a recent study, if we could tackle the problem of parental overweight, we'd cut childhood obesity in half.

Enter the ads being run in Minnesota that aim to embarrass (okay, shame) overweight parents into taking a hard look at themselves and their habits. In each an overweight parent has an "aha" moment when they realize that their (overweight) child is copying their unhealthy eating habits. (I wrote about this for the Boston Children's blog, Thriving, and for Huffington Post).

I know that these ads could hurt feelings. And I'm not saying that they should be the only thing we do--there's lots more we need to be doing. Like making sure that everyone can afford healthy food, and creating more safe, accessible and affordable exercise opportunities. Or taking a long hard look not just at our waistlines but how food is produced and marketed. 

But the BMJ study has me really worried as a pediatrician. And we can't responsibly fight childhood obesity if we don't tackle the main risk factor.

What do you think of these ads?

Please, don't give your child sugar-sweetened beverages

Posted by Dr. Claire McCarthy September 24, 2012 12:01 PM
Please, don't give your child sugar-sweetened beverages.

I'm not saying never--I'm okay with the occasional soda at a restaurant or cup of fruit punch at the party when nothing else is served. But please, don't buy it to pack in snacks or lunches or to have around the house when your kids get thirsty. Give them water, or unsweetened milk, instead.

The reason I'm pleading is that as a pediatrician, I am getting increasingly panicked about childhood obesity. I'm seeing it every day at work--and what makes me panicked is that I can't seem to get anywhere with it. At this point, I'm really happy if patients of mine don't get heavier; an incredibly small number of them actually get slimmer. 

We've known for a while that sugar-sweetened beverages are part of the problem, and this week the New England Journal of Medicine came out with three studies that show exactly that:
  • A study out of Boston Children's Hospital showed that when a group of overweight and obese adolescents cut back on their sugar-sweetened beverages they gained less than a control group that didn't.
  • Researchers in the Netherlands found that when they gave normal-weight kids one can a day of a sugar-sweetened beverage a day, they gained more weight after 18 months than those who got a sugar-free beverage.
  • Data from a big study of nurses shows that when people who have a high genetic risk of obesity drink even just one sugar sweetened beverage a day, they gain even more weight.
Now, getting rid of sugar-sweetened beverages isn't the silver bullet for ending obesity. In all of the studies, everyone gained weight. Those who drank the sugar-sweetened beverages gained more--although,if you read the fine print, not always much more. And the study out of Boston Children's underlined the fact that habits are hard to break: a year after the intervention to cut down on sugar-sweetened beverages (which included not just phone calls and visits but actually shipping sugar-free beverages to their houses), the teens who got the intervention weighed the same as those who didn't.

But getting rid of sugar-sweetened beverages is important. As my colleague Dr. David Ludwig says, we were meant to eat our calories, not drink them. Our bodies just don't seem to register the calories when they come in as liquid--if we ate something with the same amount of calories as that big cup of soda, we'd feel full. But after the big soda, we're reaching for fries. Whether or not your child is overweight (to find out, check out the BMI calculator on the website of the Centers for Disease Control), it's not good to take in more calories than we need.

It's also simple. Compared to getting your kid to exercise an hour a day or shut off the TV, talking them into drinking water (or flavored water or unsweetened milk) instead of soda or fruit punch isn't all that hard. Please, as someone who is watching the childhood obesity epidemic play out day after day, I'm begging you: don't give your child sugar-sweetened beverages.

What high--and low--expectations can do to children

Posted by Dr. Claire McCarthy September 20, 2012 08:10 AM
I heard the most fascinating story on NPR the other day. 

It was a story about how teacher expectations affect how they teach. They talked about a study done back in 1964 by a Harvard researcher named Robert Rosenthal in an elementary school in San Francisco. Rosenthal took a regular old IQ test and put a different cover on it; he called it the Harvard Test of Inflected Acquisition (stick the Harvard name on anything and people look at it differently). He told the teachers that it was a test that could show when kids were about to have a dramatic increase in their IQ.

All the kids took the test. Then Rosenthal picked some kids at random and told the teachers: these are the ones who are going to have an increase in their IQ.

Know what happened? They did. For real.

Rosenthal studied the kids and teachers closely for two years. He found that if teachers thought the kid was going to succeed, they helped them do so. They gave them more time, more feedback and more approval--all of which helped those kids learn and do better than others.

It's just human nature. We make judgments about people all the time, often--even usually--without realizing it. And those judgments can have power--and unintended consequences.

This is why I had a parenting panic moment when I found out that the middle school had decided to track kids into regular and advanced classes as they entered sixth grade. They told us this at the end of the fifth grade year--a year during which my then fifth grade daughter had done some serious slacking. I hadn't worried about it--I figured we had time--but suddenly it turned out that we didn't.

It's not that I wanted Natasha to be in advanced classes for bragging rights or resume-building. It's just that I knew from experience as a pediatrician and as a mom that she'd be pushed and learn more in an advanced class--simply because, as Rosenthal found, the teachers would expect more of her.

Ultimately, for Natasha it's not so crucial--because she has me and my husband to advocate for her and encourage her. But for so many kids, this stuff really is crucial. A teacher's expectations can make or break a life. 

Think about how this concept might play out for kids at "failing" schools, the ones with poor test scores. What is it like when the expectations for everyone are low? Or how it plays out for a rambunctious child who gets labeled as a troublemaker, or a really quiet one who gets labeled as unintelligent when she's actually just painfully shy? I've watched this stuff happen with so many of my patients. After a while, unless we've got tremendous self-confidence or someone in our corner, we start to believe what people think about us.

I don't have any great answers or ideas. But when I heard this story, I wanted to write about it. I figure if I make a couple of people stop and think, and maybe change what they do, it might make all the difference in the life of some kids.

Here's hoping.                                

It's not just a grownup problem: salt is bad for kids, too

Posted by Dr. Claire McCarthy September 17, 2012 08:10 AM
I love salt. I mean, I really love it. I love it on everything, I eat it off pretzels. This is not good for me; the sodium in salt can cause high blood pressure. So far I'm healthy with normal blood pressure, but I know that I need to do something about my unhealthy habit.

And even worse, I seem to have passed my love of salt to some of my children. If allowed, my youngest puts so much salt on his broccoli that it looks like snow. When he was younger, he'd sneak licks of the top of the salt shaker (we'd clean it all the time, just in case). My husband and I have certainly discouraged this behavior, but we haven't worried too much. After all, they are just kids, and healthy. But recently I've started realizing that I need to worry more--and do more than discourage. A study released today in the journal Pediatrics makes this particularly clear.

Researchers looked at the health and diets of more than 6000 kids. They found that the ones with higher sodium intake were more likely to have high blood pressure. This was particularly true for overweight children; for them, every increase of 1000 mg of sodium a day upped their risk of high blood pressure by 74%. For normal weight kids, the risk was much lower.

Here's why this matters. Having high blood pressure puts stress on blood vessels and causes damage. This damage adds up over time--so high blood pressure that starts in childhood is particularly worrisome. It's giving the damage a head start--and markedly increases the risk of having complications from high blood pressure, like heart disease or kidney disease or strokes.

Now, it's not certain that if your kid eats lots of salty foods (or salts their food as much as Liam loves to) he will end up with high blood pressure. But why take the chance? Is it really worth it?

Sodium isn't all bad--it's actually something our body needs.Do you know how much sodium children are supposed to have? For kids one to three, the recommendation is 1000 mg, for age four to eight it's 1200 mg, and older than that it's the same as adults, 1500 mg. Do you know how much the average intake was in the study? 3400 mg. And for lots of us, it's much more than that.

Here are three things you can do:
  • Get out of the habit of salting things. If you can, get the salt shaker off the table. Try using herbs or lemon to flavor foods. 
  • Start reading nutrition labels. Find out just how much sodium is in your food.
  • Watch out for processed foods, like canned soups and frozen dinners--they are often really high in sodium. 
This is going to be hard for Liam and me. Liam's not overweight, but I don't know that this will always be true--and I want him to grow up healthy. As for me, I want to stay healthy--I want to not just be alive to see my grandchildren, but be able to play outside with them. So we'll give it a try...getting the salt shaker out of our reach will be a good start.

You can't make your kid take a leap of faith

Posted by Dr. Claire McCarthy September 13, 2012 07:49 AM
The other day, my husband and I tried to teach our 7-year-old to ride a bike. It didn't go well.

It wasn't the first time we'd tried. We've tried lots of times, to no avail. Liam just doesn't want to do it. Mostly, he doesn't want to do it because he doesn't think he can--actually, he's certain that he can't. 

I do sort of see where he's coming from. It really is a bit improbable that one could actually balance on those two thin wheels and move forward. It doesn't matter that you see people do it all the time. To ride a bike, you have to believe that you can do it--and you have to want to try. You have to be willing to take a leap of faith.

Liam doesn't want to take that leap--and I can't make him.

Coming to terms with this concept has been one of the tougher parts of parenthood for me.

There are times when I want the kids to do something, because I think they have the talent for it and it would be fun and good for them--like when I wanted Michaela to keep taking ballet, or Natasha to try out for the school play. These are things that are stretches for them, that require a leap of faith. At this point in parenthood, I've learned to get over it when they don't want to take those leaps. After all, these are usually things that I want, not things they want. And ultimately, they don't matter.

But some things do matter, and that's when I have more trouble. There are times when my heart breaks for one of my children because I know they have it in them to learn Latin, or get out of a bad relationship, or make new friends, or swim an elusive qualifying time...and all that is stopping them is, well, them. They hold themselves back--they don't believe in themselves, or they don't have the passion or will they need, or both. I've tried encouraging, cajoling, yelling, bribing--nothing works. It has to come from them.

In parenthood, we can only take them so far. We can love them and nurture them and teach them and give them opportunities...but whether and when they put their feet on the pedals and take off down the path is ultimately not ours to decide.

I haven't given up on teaching Liam to ride a bike, though. A friend suggested I try rollerblading alongside of him, holding on to the bike. If nothing else, it sounds like fun.


It's flu shot time! Answers to common questions.

Posted by Dr. Claire McCarthy September 10, 2012 11:10 AM
It's flu shot time! Just last week our clinic's supply arrived and we started giving it out. While most families are happy to get their child immunized, every year I talk to families who have questions and concerns about the influenza vaccine.

Here are the questions I'm most commonly asked:

My child is healthy. Why does he need this vaccine?
Over the years, I've come to have great respect for influenza and how sick it can make people--even healthy people. Yes, there's a chance that your child won't catch it--or that if he does catch it he won't get very sick. But there's also a chance that he will get very sick.

It's also important to vaccinate your children in order to protect other people. Your son may only have a mild case, but he could easily infect Grandma, or the neighbor with cancer, or your friend's newborn. By immunizing as many people as possible, especially young children, we keep everyone healthier.

Everyone should be immunized. But the people that the CDC most wants to get the vaccine include:
  • Children 6 months-4 years (because the young are more likely to get very sick, and are infection-spreaders)
  • People with asthma, heart disease, and other chronic health conditions--and any one with lowered immune defenses, like people on chemotherapy.
  • People on aspirin therapy
  • People older than 50.
  • Pregnant women 
  • Caregivers of children (especially children less than 6 months since they are too young to be immunized) or the elderly
  • Health care workers, and caregivers of people with health problems
Can't you catch the flu from the flu vaccine?
No. You can't. The shot has inactivated virus in it that can't cause an infection. The nasal spray, or LAIV (live attenuated influenza vaccine), is not completely inactivated--but it's been changed in a way that stops it from causing infection. There is a slight chance that LAIV could possibly cause an infection in someone with a weak immune system, which is why we don't recommend it for them or anyone who lives with them. 

Every year, scientists make their best guess as to which flu viruses are going to cause trouble--and usually, they are right. But occasionally they are wrong, and there are various flu viruses out there--so it's possible to get the flu shot and still get the flu. Also, it can take a couple of weeks after the shot for it to have it's full effect, so it's possible to catch the flu in that period (that's why it's good to get it early in the season!) But if you get it, it's a coincidence--it's not from the shot.

Aren't there dangerous side effects?
Every medical treatment has possible side effects, and the flu shot is no different. It's not uncommon to feel a bit achey and sick for a day or so after the shot, or even get a bit of a fever, and if you get a shot your arm may be sore. But more serious side effects are very rare.

Should my child get the nasal spray or the shot?
If your child has a health problem or is less than 2 years old, we recommend the shot. We have more experience with it, and it is a completely inactivated virus. But if your child is over 2 and healthy, the spray may even be slightly more effective--and most kids are happy not to get a needle. To learn more about LAIV, read the LAIV page of the CDC website.

Why does my baby need two flu shots?
For children under age 8 who have had less than two doses of flu vaccine since July 1, 2010, two doses are recommended to be sure they get enough protection. The second dose should be  given at least 4 weeks after the first.

What about preservatives?
Multidose vials of influenza vaccines (bottles that hold enough vaccine to immunize a bunch of people) contain a small amount of preservative (thimerosal) so that bacteria and other germs can't get into the vaccine once the bottle is opened, something that could be very dangerous. This small amount of preservative is felt to be very safe. Single dose vials, and LAIV, do not contain any thimerosal (nor do any of the vaccines we give children under the age of 6). 

To keep your family healthy this flu and cold season, teach your children to cover their coughs and sneezes--teach them to use the inside of their elbow rather than their hands, as hands often go on to touch things like doorknobs. And wash your hands, all the time! When using soap and water, sing the Happy Birthday song to be sure you're washing long enough; if you use hand sanitizer (make sure you always carry some with you), make sure that you use plenty and really rub it between your fingers.

If someone in your family has the symptoms of the flu (such as fever, cough, runny nose, vomiting, diarrhea or generally feeling lousy), call your doctor. In some cases, treatment with antiviral medication is a good idea.

Both the American Academy of Pediatrics and the Centers for Disease Control have lots of information about influenza and influenza vaccine on their websites. And talk to your doctor--he or she knows your situation, and is likely the best person to answer your questions.

The gift of my summer vacation: gratitude

Posted by Dr. Claire McCarthy September 7, 2012 07:50 AM
For the last two weeks of August, I was on vacation with my family. I figured I'd come back with all sorts of good blog fodder; after two weeks of spending 24 hours a day with five kids ranging in age from 21 to 6, I thought I'd have all sorts of stories to tell.

There were a few stories, like Liam's first experiences with being tossed by waves (undaunted, he ran back in and got tossed even more) and Zack catching a fish in his first five minutes of surf casting (that was the only one he caught all vacation). But what I mostly came back with was gratitude.

It was the first time we'd been together as a family in a long time--Zack was away all summer doing an internship in DC--and the first time in an even longer time that we'd spent a continuous stretch of time together, with nobody going to work or school or off with friends. It could totally have gone either way, all that togetherness.


But we liked it. All of us. We had a good time together. And I know only too well from twenty-one years of parenthood that having a good time together is never to be taken for granted. Ever.

Nor is the health of one's family. Or that everyone--or anyone--in it is happy and successful. All of this can change on a dime, and should be recognized and treasured. Not only because it's the right thing to do, but because gratitude can make us really happy. And peaceful. 

I guess that's the thing I found myself thinking most about: that we are never even nearly grateful enough. We spend way more time wishing for things we don't have than appreciating what we do have. I'm as guilty of that as anyone.

So I'm holding the memories of this year's vacation close to my heart as I reenter the crazy fray of life. I'm hoping that they remind me to be grateful, whenever and for whatever I can.

Parents of football players: how you can prevent brain damage from concussions

Posted by Dr. Claire McCarthy September 5, 2012 03:56 PM
There's news out today about a study that showed that professional football players are at higher risk of death from diseases that damage cells in the brain. Researchers think this is because of chronic traumatic encephalopathy--which is what happens when you get many concussions.

There's been a lot of talk recently about preventing concussions in athletes--especially football players. I'm really glad that people are taking this so seriously; as this most recent study underlines, those bumps to the head that we used to think were nothing, that we used to expect players to shrug off and get over, can cause lasting brain damage.

If your kid plays football, here's what you can do to keep his (or her) brain safe and healthy (hopefully you know this already):

Make sure your child has and uses the appropriate safety gear, especially a helmet. Make sure all safety gear fits and is worn properly.

Make sure your child's coach is educated about concussions and how to prevent them--and that he or she enforces safe play rules. Ask for details about how they and the league are going to protect your child. Winning should never be at the cost of anyone's brain. 

Know the symptoms of concussion. They include:
  • headache
  • dizziness
  • sleepiness
  • nausea
  • fatigue
  • confusion, or memory loss
  • clumsiness, trouble with balance or difficulty doing normal activities
If your child has any of these symptoms, do not let them back in the game. This is crucial. I don't care if it's the championship game or the college recruiter is there. They must stop playing.

If you think your child might have had a concussion, call your doctor. It's important to get medical attention after a concussion.

Follow your doctor's instructions to the letter. Recovery from concussion requires rest--physical rest, and mental rest too. It can be boring and frustrating sometimes, but it's really important not to rush recovery. Your child may be itchy to get back to playing, but it's just not worth the risk.

Learn about concussions and concussion prevention. Visit the Boston Children's Hospital Concussion page and the Heads Up page of the Centers for Disease Control website.

Obesity is bad for kids' brains

Posted by Dr. Claire McCarthy September 3, 2012 07:26 AM
There's a scary new study showing that obesity can hurt kids' brains.

It's not news that obesity is bad for kids. It increases their risk of diabetes, cardiovascular disease, orthopedic problems and a whole bunch of other health problems. But what this study in the journal Pediatrics is talking about is different: it's talking about effects on the brain.

Researchers looked at 49 adolescents with metabolic syndrome. Metabolic syndrome, a consequence of obesity, is the triad of insulin resistance (pre-diabetes or diabetes), high blood pressure and high blood lipids. The researchers compared the adolescents with 62 adolescents who had the same socioeconomic background but didn't have metabolic syndrome.

The kids with metabolic syndrome had more trouble with arithmetic, spelling, attention and mental "flexibility" than the ones who didn't have metabolic syndrome. Even more frightening, the researchers saw actual changes in their brains, in the hippocampus (which plays a crucial role in memory) and the white matter (which passes messages through the brain).

It was only a small study, and not all kids with obesity have metabolic syndrome. But this study is alarming--especially since we don't know if losing weight can make the brain go back to normal. Given that brains are still developing in adolescence, it's very possible that the changes could be permanent.

What else do we need before we take the problem of childhood obesity really seriously? More and more, it is becoming clear that obesity can steal a child's future away.

In another study in the same edition of Pediatrics, German researchers looked at all the risk factors for childhood obesity and calculated which had the largest effects. You know what the two biggest factors were? Parental obesity and media time. If we tackle those two, it would have a bigger effect than getting kids to exercise or eat fruits and vegetables, they say. So as we start out this new school year, let's shut off the television and video games--and parents, when you are buying back-to-school shoes for the kids, pick up a pair of sneakers for yourself.

Let's work together to get our children's future back.

About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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