Tag Archive for: kids

Childhood Obesity: A Family Thing

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I hope you took some time to scan the Executive Summary of American Association of Pediatrics Guidelines for Physicians. If you couldn’t, here are the three things that stood out to me.

Screening by Pediatricians and Primary Care Physicians

The focus of the guidelines was to assess risk factors for degenerative disease such as heart disease and diabetes in children who exceed the 85th percentile of the normal growth charts, indicating overweight, and 95th percentile, indicating obesity. The guidelines recommend beginning at 2 years of age and continuing through 18.

Were there recommendations for the use of medications and bariatric surgery in children over 12 and 14 respectively? Yes, but they were referrals to specialists for evaluations, not a blank invitation to write prescriptions.

It Must Be a Family Thing

Without exception, the guidelines recommend intensive health behavior and lifestyle treatment. “Health behavior and lifestyle treatment is more effective with greater contact hours; the most effective treatment includes 26 or more hours of face-to-face, family-based, multicomponent treatment over a three- to twelve-month period.”

That’s not the same as giving Mom and Dad a diet for the child and sending them on their way. Family-based programs have demonstrated great success, but it has to be a family thing.

It’s All About the Money

The summary also talked about obstacles to the family-based treatment approach. The major obstacle is money:

  • Money for training pediatricians and family practice physicians on how to assess childhood obesity.
  • Money for training more people to teach and work with families—it’s labor intensive.
  • Money for public health and community programs that can support the family-based approach.

It’s a situation we’ve seen many times: Everyone knows how important preventive healthcare and early treatment is, but no one wants to pay for it. But maybe we shouldn’t always look to government to foot the bill; maybe schools, community organizations, and churches could offer programs for their members. If what we’ve always done isn’t working, let’s try something different.

The Bottom Line

The guidelines introduce a couple of new approaches for those with the most severe weight problems, but the focus is on intensive nutrition and behavior-change training for the entire family. That’s not just “Here’s a diet and exercise program, and I’ll see you next year.” The guidelines give a reasonable approach to help the future health of the nation. The approach is simple: Eat less. Eat better. Move more. What they’re saying is that healthcare professionals need training to be able to do that effectively as a team in a reasonable family-based approach. That’s the right approach as I see it.

What are you prepared to do today?

        Dr. Chet

Reference: Pediatrics e2022060641.https://doi.org/10.1542/peds.2022-060641

New Guidelines on Childhood Obesity

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If you pay attention to health news, you know the American Association of Pediatrics issued new guidelines on how to treat childhood obesity. Depending on where you read or listened to how those guidelines were presented, all you may have heard is that kids over 12 can get medications to help with weight loss and teens over 14 can have gastric by-pass surgery.

Then the experts weighed in (no pun intended). One pediatric physician predicted doctors would just pull out the prescription pad and not address the root cause of obesity. Psychological experts said this is going to cause increases in disordered eating, which includes anorexia and bulimia.

This story hits home for me because food was love in a Polish household like mine. I’ve been overweight since I was around eight years old, and it’s been a life-long struggle to get to a normal BMI. But even at my heaviest, I was nowhere near the weight many kids are today.

Is that all that was in the guidelines? You can read the summary at the link below. Then on Saturday I’ll break them down to get the bottom line.

What are you prepared to do today?

        Dr. Chet

Reference: Pediatrics e2022060641.https://doi.org/10.1542/peds.2022-06064

Sports for Kids: A Better Way

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I hope you took the time to read the Norwegian Children’s Rights in Sport document; if not, please do, especially the Plan for Development. The focus is on making sure the child is safe and secure no matter their abilities. The goal is for all kids to develop the joy of learning sports by having fun and gaining lifetime skills.

The kids also have the right to master a variety of skills in many sports. The ages 6 through 12 are not for specialization, they’re for generalization. Kids have the right to decide how much or how little they want to participate in sports and much they want to train. That doesn’t mean that this is all willy-nilly; it’s very organized with progressions from skill to skill and sport to sport.

Let me use the illustration from the last Memo about dodgeball. If kids are put into groups with similar abilities, they can still play dodgeball. They can develop their eye-hand coordination much better than if they avoid that game altogether. They can be given drills that allow them to focus on the ball release, to anticipate which direction to move, and how to catch the ball. The progression may be different and slower than more talented kids of the same age, but they will progress. They may never play dodgeball again, but they can develop skills that help them become a goalie in soccer. If they grow into their teenage and young adult bodies with better skills, who knows where that may lead? The most important point is for kids to learn to associate sports with having fun.

There are two elements that are the antithesis of American youth sports. Travel teams are prohibited, and no scores are kept for any game up to the age of 12. Local communities can have competitions within a reasonable distance and that’s encouraged, but nothing like the travel teams we see in the U.S.

No keeping score? It’s prohibited and if caught, coaches and parents are subject to penalties. They’re also not allowed to keep statistics: no leading scorers, no saves in hockey. The emphasis is on learning a variety of skills in many sports to encourage life-long activities.

I haven’t seen documentation of long-term effects, but it would be reasonable to anticipate a reduction in obesity and a less sedentary lifestyle than we have in the U.S. today, and that could reduce healthcare costs. We might even find a smaller carbon footprint if people are more inclined to walk or bike or ski to their destinations.

Where’s the Competitive Spirit?

Don’t be deceived—competition is encouraged at the right time. Once children over 13 decide they want to become competitive athletes, the training escalates with more info on nutrition, practice of sport-specific skills, and higher levels of competition. Once they’re in, they go all in. Remember this: the first kids who went through this change in the approach to sports for kids are the young adults who won all those medals in the last Winter Olympics. Now they’re turning their attention to the sports in the Summer Olympics.

Competitive? Of course they are. They just want to end up with a population of adults who have a life-long appreciation for movement and a commitment to keep going. So far, it seems to be working.

The Bottom Line

I think anything that helps kids develop an appreciation for movement is a good thing. Could the Norwegian way work in the U.S.? Most likely not because the current system of an exclusionary approach to sports is so entrenched, but it could work within a community or a school district. If the focus is on playing, having fun, and getting good coaching in sports skills all year round for young kids, that could translate to benefits for all ages. Maybe it would prevent the burnout student athletes experience who start competing at six years old. By the time they finish high school, too many are done. For life. That costs the child and it also costs society.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.aspeninstitute.org/blog-posts/norway-won-winter-olympics/

An Alternative Path for Athletic Kids

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At the last Winter Olympic Games, which country won more medals than any other? The U.S.? China? Russia? No, it was Norway—a record 39 medals. How does a country with about five million people outperform countries such as Germany with 80 million, Canada with 35 million, or the U.S. with 325 million? As you might expect, there isn’t one simple answer, but it may be related to their approach to sports for kids.

In 2007, the government of Norway adopted a set of rules called Children’s Rights in Sport; you can read the document by clicking on the link in the references. Their approach begins with the premise that kids should play sports because they enjoy it and that what they learn with their friends will last a lifetime. So the very first idea is that sports will be a life-long activity. Contrast that with the approach to sports in the U.S. As we proceed through elementary, high school, and college, fewer and fewer people participate in sports on a regular basis. The emphasis is on competition, not life-long skills, so the kids with an average amount of skill learn that if they’re not a star, sports isn’t for them. They become sedentary adults.

Ever play dodgeball in phys ed class? You probably remember kids with rocket arms mixed with kids a foot shorter and poor reaction times. How well does that work out most of the time? The entire Norwegian approach focuses on developing sports skills consistent with the abilities of the child, not on the kids who perform best. The approach involves community sports clubs. The approach takes whatever skills a child has and helps them improve with children of similar abilities, including children with physical disabilities.

How does this approach lead to better performance in the Winter Olympic Games? We’ll continue on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Children’s Rights in Sport

Kids and Sports in America

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In my travels, I stay in a lot of hotels and speak in many venues from convention centers to hotel ballrooms. No matter the season, I can count on there being a team of kids staying in the hotel. I don’t mean professional teams; I mean kids’ teams from baseball and softball, gymnastics, volleyball, and of course the number one sport, soccer. Pick an age group and there’s a team tournament being held somewhere. I don’t mean local community events; I mean that the kids participate in travel teams, which means the entire family travels.

I recently saw a segment on youth sports on a national sports show. One of the scenes that stood out to me was a parent using profanities toward the umpire or referee. I used to be a football official and took my share of abuse. No one used profanities at games, but that was 20 years ago and things are much different today. Kids with some talent who show an interest in a sport can get moved along rapidly to higher levels of competition. It seems that failure is not an option once they get there.

What does this focus on competition at early ages do to kids? Is it healthy? Does it create champions? Hard to say for sure, but there may be another way, one that leads to lifetime participation in sports and activity. We’ll take a look on Thursday.

What are you prepared to do today?

        Dr. Chet

Did Probiotics Help Preschoolers with Gastroenteritis?

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The use of probiotics to stop diarrhea and vomiting for preschoolers with gastroenteritis (GE) was studied in two major studies published in the New England Journal of Medicine. In the U.S. study, 55 of the 468 subjects who got the probiotics had scores of nine or greater on the scale while 60 of 475 in the placebo group has scores of nine or greater for the two weeks after the study began. This was a 20-point scale and the higher the score, the worse the GE symptoms. No significant differences.

In the Canadian study, 108 of the 414 subjects in the probiotics group and 102 of the 413 subjects in the placebo group had scores of nine or greater for the two weeks after the study began. Again no significant differences were found.

This led both research groups to conclude that the probiotics used in the studies were ineffective in preventing negative GE outcomes compared to those who received the placebo.

The press releases and follow-up interviews were much harsher in their criticism of probiotics. One of the study leaders concluded that “These two probiotics did not work. They should not be used for GE.” I would emphasize “period!” was implied. But is that true? If you’re a regular Memo reader, I’ll bet you have an idea where this is going; I’ll explain on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.
2. N Engl J Med 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

 

Preschoolers, Probiotics, and Gastroenteritis

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Estimates are that close to two million preschool children will be taken to the emergency room for vomiting and diarrhea every year; the term generally used is gastroenteritis (GE). Two research groups, one from the U.S. and one from Canada, conducted studies to see if probiotics would have any impact on the course of GE from the time of the ER visit for at least two weeks after. Here’s what they did.

Researchers in Canada recruited close to 900 children and researchers in the U.S. had close to a thousand; all the children had symptoms of GE. The subjects were randomly assigned to a placebo or experimental group. The subjects in the experimental groups were given a five-day course of probiotics; the Canadian group used two strains and the U.S. used one strain. The subjects were then tracked to see whether there was a difference in the severity of the GE between those kids getting the placebo and the ones getting probiotics. Both research groups used the same GE symptom scale to monitor the severity of the GE.

Did the probiotics have any impact on the severity of the GE? We’ll check out the results on Thursday.

What are you prepared to do today?

Dr. Chet

 

References:
1. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.
2. N Engl J Med 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

 

Last Was First

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What was the roar I told you about in the last message? It was for the last runner of the Grand Rapids Kids Marathon. You can see him in the group picture: the kid on the far right with the walker in the cool shades. I don’t know exactly what his condition is; most likely a muscular disorder of some sort. But that didn’t stop him from participating.

His mom accompanied him the whole way. When he came through the aid station, he wanted a cup . . .

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Kids Marathon

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One of the requirements of a triathlon training group I belong to is to volunteer at a running or other event. This past weekend, the Grand Rapids Marathon held a Kids Marathon. I was in—not just to help, but experience what this type of event is like.

The idea is this: kids run or walk at least one mile, three times a week, with a friend or family member and track their progress on a training sheet that goes through mile 25. On race weekend, the children run or walk the last 1.2 miles of the marathon distance . . .

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Healthier Eating for Kids

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In the last message before Labor Day, I wanted to provide you with a few references to help your kids eat better. It’s something that I’ve never done before but frankly, I just don’t know everything and I’m not going to live long enough to learn it all. I hate that, but every man’s got to know his limitations. Yes, that’s one of my favorite movie quotes.

Two are books that I referenced in earlier webinars; the other two are books by long-time readers who are passionate about helping kids eat healthy. I . . .

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