Battle strategies to combat youth obesity

The average child spends 900 hours a year in school yet still manages to squeeze in 1,500 hours for television - and that doesn't take into account the amount of time dedicated to playing video games and surfing the Web. In comparison, fewer than one in four children get at least 20 minutes of vigorous physical activity every day.

"Basically, kids are very inactive," says Liz Price, M.S., president of Energized by Exercise Kids Fitness Programs Inc. in Waco, Texas.

This inactivity comes with a cost. Obesity affects one in five children in the United States, and type II diabetes - a disease once associated with overweight adults - is becoming alarmingly more prevalent among youngsters.

Still, the next generations aren't necessarily doomed to an overweight fate. Exercise and nutrition programs can combat obesity, and, indeed, children's programs are not unheard of in this industry. Perhaps your club even offers activities for youngsters.

The problem, however, is that many children's programs favor kids who don't already suffer from the hardships associated with being overweight. Obese children need special activities suited to their abilities. Unfortunately, they don't have many options available to them.

That's where health clubs come in.

"Clubs would be a great linkage for children with an obesity problem because there is nothing out there really," Price says.

With obesity on the rise, there is a strong need for clubs to provide programs that can help overweight children. Many clubs already have the appropriate experts in place to make weight management programs work for youngsters. Personal trainers know how to show adults ways to replace sedentary behavior with activity; they just need to learn how to modify their approach for children.

The best way to get overweight children motivated is with noncompetitive activities, believes Mirabai Holland, president of Mirabai Holland International Inc., in Ridgefield, N.J. Obese youngsters may not have the stamina or confidence necessary to take part in sports. Therefore, they require programs that help them develop their personal best, not programs that force them to compete with other kids.

Eagle's Circle - an eight-week program offered by Pfizer U.S. Pharmaceuticals specifically for 10- to 15-year-olds who suffer from asthma and/or obesity - helps youths achieve their personal best by kicking off and ending with a fitness evaluation that measures the strength, flexibility and aerobic capacity of each child. This gives the instructors an idea of the children's capabilities while showing the kids that they aren't in competition with the other program's participants.

"For many of the kids, it's really a revelation to get their own profiles," says Jim Sgritto, marketing manager of Pfizer's pediatric health team and an exercise physiologist who created Eagle's Circle. "They see where they are at, and, in order to be successful, they don't have to be better than anybody else."

After the eight weeks, the youngsters can use the fitness assessments to gauge their progression. Along the way, they take part in a variety of activities that Sgritto borrowed from other disciplines. The children do breathing exercises, stretching, tai chi, karate, Step aerobics, strength training and relaxation techniques.

Noncompetitive activities such as these may put children at ease, but instructors can still turn kids off with their attitude and appearance. Again, overweight children may suffer from poor self-image. They won't be able to relate to trainers who show up for a class wearing short, tight clothes that accentuate their muscular figures. "I wouldn't have an instructor come in with a real aerobic-type outfit on," Price offers. "It would be more like shorts and T-shirt."

Instructors not only should dress in a manner that make the kids feel comfortable, they should be receptive to input from the youngsters. Ask them what type of music they want played during a class, and find out what activities interest them. Take what the club offers for adults and think of ways to apply it to children. In fact, you can even move them outside of the club. Teach a walking program. Get them inline skating. Have some fun. The goal is to give the kids options.

"Just like adults, children will find one activity they will gravitate toward, and hopefully, start to do that exercise for a lifetime," Price says.

While an average club probably possesses enough talent and know-how to launch a program for obese children, partnering with outside experts can benefit everybody involved. For example, a club can ask a pediatrician to examine the program - just make sure that the presentation won't intimidate an overweight youngster with low self-esteem. At the same time, the club can ask the pediatrician to refer children into the program. As Price points out, pediatricians recognize the growing danger of childhood obesity, but they often don't have anywhere they can send kids to exercise.

"Before the old stigma was that pediatricians aren't involved, they aren't aware of the problem," Price says. "That's not the case nowadays. Pediatricians are very aware of the problem. Yet what can they do? There is no program just for the children."

Holland agrees that, thanks to new research, pediatricians want to take action against childhood obesity. However, when a pediatrician promises you referrals, makes sure he is truly committed. Four years ago, Holland created a children's weight management program called POW (Personal Optimal Wellness) for a club in Paramus, N.J. A local pediatrician promised he would send 30 kids to start off the program. He referred six. The club eventually cancelled the program.

Pediatricians aren't the only experts who can make a contribution. Dietitians can also add a great deal. After all, a true weight management program requires a nutrition component as well as an exercise component.

The Bright Bodies Weight Management Program for Kids at Yale-New Haven Children's Hospital (New Haven, Conn.) combines cardio cross-training with nutritional advice, courtesy of a dietitian. "She uses a non-diet approach," explains Richard DeStefano, pediatric coordinator. "She emphasizes healthy food choices. [The children] gain some insight into food intake."

Teaching children about a healthy diet can help them overcome obesity, but only if the instructor can maintain the kids' interest. Make sure you speak in terms they understand - without talking down to them. For example, in her lecture on fiber, Price compares the human body to a washing machine, which fiber helps clear out. She then tells the kids that brown cereal has more fiber than colored cereal and, therefore, is better for them.

Price is also careful of her word choices when discussing nutrition with children. She refers to the fat in food as "grease." Why? She doesn't want overweight kids to think they are bad because fatty foods are bad.

"With fat, kids tend to internalize it and think of the fat on their bodies," Price explains. "But when we're talking about grease, we're talking about something inside food."

Kids can get restless, so you'll have a hard time holding their attention if your nutrition component consists solely of lectures. You must get them involved. In the POW program, kids went to the supermarket, where they learned how to shop for healthy food. They also cooked healthy meals in the club's kitchen. Naturally, they had a great time.

By emphasizing the importance of exercise and a healthy diet, a weight management program can modify the behavior of children. Since they are young, time is on your side. They haven't had many years to form unhealthy habits, so it's easier for them to change - just as long as you reward their positive behavior.

In the Eagle's Circle, the kids earn special rewards for participation. They receive an Eagle's Circle jersey at the second class, a pair of shorts at the fifth class, and a hat at the eighth class. "It gives them a sort of badge of honor," Sgritto says.

Positive reinforcement can create a healthier lifestyle, but to change a child's habits completely, you must also change the parents. After all, kids aren't buying the groceries and cooking dinners; their parents are. That's why the POW program included parents in the shopping trips and taught them about healthy foods. It's also why Price gives children handouts to take home after nutrition lectures. For example after her discussion of fiber, she sent home a handout urging parents to buy high-fiber cereals and whole wheat bread.

"I find that I educate as many parents as I do children," Price says.

Educating parents about nutrition isn't enough. Moms and dads must also learn about the benefits of active lifestyles. Invite parents to come watch one of the children's exercise sessions, then afterward, talk about ways families can get active together. Encourage them to take walks or go biking. They can even alternate activities, giving each family member a chance to choose what to do. That way, no one gets bored, and everyone remains active.

Asking parents to join in certain activities is advisable, but you don't want them around all the time. Obese children often feel frustrated, and a weight management program should give them a chance to express what they are going through. However, they may not have much to say in front of their parents.

"Kids really open up when their parents aren't around," DeStefano says.

As part of the Bright Bodies program, children take part in a session called "Handling Our Feelings." Overweight kids are frequent targets for teasing, and this session takes some of the sting out the taunting. "These kids are being picked on all the time," DeStefano notes.

Sharing their feelings allows children to vent, form bonds, and feel better about themselves. They also feel better about themselves when they meet other kids who have endured what they have endured and come out on top. Bright Bodies includes visits from past participants who completed the program with great success. For example, one girl who completed the program more than three years ago recently came back to tell the current participants about her experiences. She lost 15 pounds in the program and gained new self-confidence.

"She talked about what she went through emotionally, being picked on, being called this and that," DeStefano says. "She's now one of the most popular girls in her school."

A success story like this can give overweight kids the incentive to stick with the program. But it isn't enough. A weight management program for kids must mix exercise, nutrition and counseling. Most importantly, it must be fun.

"I think the main thing with kids, healthy or unhealthy, they want to be motivated and engaged," Holland says. "They don't just want to hang out."


Targeting Teens

Children aren't the only youngsters who face the problems of obesity. Teens, too, could use more play, less PlayStation. They need programs to get them active, and they need clubs that can provide those programs.

A great time to offer teen programs is around when they are coming home from school - say 4:30. The programs, themselves, can draw on adult classes for inspiration. In fact, they should.

The 92nd St. Y in New York City started its teen programs with a few simple aerobics classes. The adolescents were quick to respond with suggestions.

"We started getting requests from teens for activities they saw their parents doing, like Spinning, Yoga, boxercise, kickboxing," says Stacey Eisler, the Y's associate director.

The Y responded by creating new programs called Teen Kickboxing, Teen Boxercise, Teen Yoga and Teen Spinning. In appearance, these classes are exactly the same as their adult counterparts; however, the addition of the word "Teen" to the class titles make the adolescents feel like the programs are just for them. And that's important.

"They like what their parents like, but they like to have it called 'teen,' " says Mirabai Holland, president of Mirabai Holland International Inc. in Ridgefield, N.J. "They want to be with their own peers."

In addition to the teen exercise classes, the Y offers "Finding Fitness" workouts. Teens participate in a small, intimate group that a trainer leads through the gym. The teens get a personal touch, yet enjoy the camaraderie of working with their peers.

"If anybody could use some one-on-one attention, it would be a teenager who isn't familiar with all of the equipment and also may not recognize that certain pieces of equipment in the gym just aren't physically appropriate for a youngster," Eisler says.

When putting together a program like this for teens, choose your instructors with care. Teens want to look up to their instructors, and, if they can't, they'll look elsewhere.

"There is this whole kind of hero worship thing that goes on," Holland says. "If they don't have a good facilitator, they'll drop the program even if they enjoy the activity. If they don't have a role model they can emulate, they just won't do it."

- J.J.


Nature vs. Nuture

People who suffer from obesity may shrug off their problem by arguing that they are genetically predisposed to being overweight. In other words, there is no reason for them to change their habits because their genetics, not their actions, are to blame for their obesity. And if their children are overweight, well, what do you expect? It's genetics.

That's a thin argument.

The quick rise in childhood obesity indicates that genetics are not completely at fault. "Despite obesity having strong genetic determinants, the genetic composition of a population does not change rapidly," says Liz Price, M.S., president of Energized by Exercise Kids Fitness Programs in Waco, Texas. "If it were genetics, it would take thousands of years to manifest itself."

The fact that childhood obesity has increased so much, so fast, gives the medical community reason to believe that the environment - that is, a sedentary lifestyle with a poor diet - is the clear culprit. And it doesn't take much to cause obesity in youngsters. A 2 percent decrease in physical activity over a period of several years will lead to a child becoming overweight, according to Price.

- J.J.