Question: Is elevated blood pressure a normal finding in obese children, and is intervention necessary before an exercise program is initiated?

Answer:

Some things that we see that is associated with unhealthy increases of weight in children is a group of associated risk factors that in later in life contributes to the development of coronary artery disease and other cardiovascular diseases. It is important to make certain that blood pressure readings are accurate. Thus, the blood pressure has to be measured on more than one occasion to ensure that the high blood pressure was not just because the child was nervous or simply a normal variation in blood. If the blood pressure of a child is substantially elevated then, a more complete workup is needed. This would include an evaluation of the child’s cardiovascular system and kidney function. Sometimes we see high blood pressure that is a result of kidney disease.

Once the appropriate tests have been done and it appears that high blood pressure is most likely associated with the obesity, the focus should be on treating the obesity. At this point, exercise testing would be a good idea to see what the blood pressure response is to exercise. For an obese child it would be important to perform what is called a sleep study. The reason that a sleep study is important is that many children with obesity, like many adults with obesity, have abnormal sleep patterns. These abnormal sleep patterns are known to contribute to high blood pressure. Once these tests are complete, focus on helping the child through a program of exercise and diet to try to lose weight.

It is unfair to assume that just because a child is overweight that he or she is not physically active. There are many heavy kids who are very physically active. This is important for two reasons. First, if a child is already getting a lot of exercise, it is going to be very difficult to get that child to do more physical activity. Second, if we want to make some attempt to prescribe for a child and his or her family an integrated program that includes changes in diet and changes in physical activity, we really need to know precisely how fit the child is.

Question: Is it safe to promote vegetarianism in children?

Answer:

A carefully constructed vegetarian diet in which the parent or guardian pays careful attention to supplying their children with appropriate nutrients can work well. The guidelines can be found with groups like the American Dietetic Association, which can really give children a very balanced, healthy vegetarian diet that can include all the necessary proteins for growth and development.

It is a mistake to think that you cannot get obese from a vegetarian diet. You can. It is like any diet. The diet has to be constructed for appropriate calories and the need to make sure it is well balanced in terms of the essential food groups and amino acids.

Question: Is it okay to encourage exercise in a child, or should it come naturally to them?

Answer:

The answer to this question is a struggle for many. There are many barriers in our society that keep children from natural physical activities. Some of these barriers are environmental. Some of them are psychological. For example, very few parents regardless of neighborhood, be it the richest or poorest, are secure about just letting their children go out in the neighborhood to play. As a consequence, children are either at home, if their parents are unavailable or they are at school, which is often inadequate. If parents have the means and the inclination, they get enrolled in organized sports. Too many children watch too much TV, an average of 40 hours per week. We live in a society where there are not enough playgrounds, not enough safe areas for natural play for children. These are some of the environmental barriers.

Coupled with this are psychological barriers. A study of middle school girls, in whom we know there is a marked reduction in physical fitness and physical activity, illustrates this fact well. While we are not completely sure why this is happening, it appears to be related to how kids perceive themselves, their body-image, what a girl should be doing at that age, which often does not include being active in sports and other similar factors. We need to encourage and provide opportunities for children to maintain a healthy level of physical activity.

Question: My nephew is eight, and he already weighs 105 pounds. He is tall for his age but has really put on weight in the past 6-8 months. My family is concerned. What can be done to help him, and what should my sister do to help the situation as it is her child?

Answer:

A sudden weight gain in a child can come about for a number of reasons. One of course is the possibility that there was some change in the child’s family situation: a trauma, a death, or a divorce. Children, like adults, can become depressed. With depression there can be sudden changes in eating habits in either weight gain or weight loss that appears to be sudden in nature. A pediatrician can best evaluate the sudden changes.

We need to find out why this is happening. Was he is a soccer league and now has stopped? Was he more active in team sports and now no longer interested or had a bad experience? Are his parents taking him to fast food places more frequently? These are the issues that the child and the family and the pediatrician need to investigate.

All this is important because we now know two very important facts: 1) The rate of childhood obesity is reaching epidemic proportions. Over the past 20 years, we have seen a steady increase in the weights of children of almost every age. 2) We know that there is a pretty good relationship, though not an absolute one, between body weight in childhood and body weight in adulthood.

Because obesity is associated with the great number of health problems later in life, it makes sense to try to address this problem earlier than we have been. However, at the same time, we must not make children fearful of eating. Like adults, wise food choices are a good idea. A major problem is the environment in which we live in which high fat foods and high sugar foods, especially beverages, are the mainstay of so many fast food restaurants, and these fast food restaurants play so important a role in the social life of our children. See our section on diet and nutrition.

Question: How should one encourage team sports to a kid who seems disinterested?

Answer:

This is a difficult question. We probably don’t need to specifically encourage team-sport participation as much as provide opportunities for children to be outdoors, i.e., away from television and computers. It’s interesting to not that when children are outside, they always seem to find a way to occupy their time by exploring, making up their own games, or joining other children in fun activities. As an example, on a study done on young girls, rather than seeing an improved fitness in girls in general, we have seen an attempt by schools to identify those girls that are talented athletes and to promote them. That is usually through team sports. At times this may be done often at the expense of teaching all children how to become fit and stay fit. For a child who says he or she doesn’t particularly like team sports, we need to explore this and try to find out why. The key is to offer to such a child alternatives focused on individual fitness programs, such as running, walking, learning how to do weight training if this is available, hiking if it can be done nearby, and other activities.

These are the kinds of individual efforts that some children find more enjoyable than the often stressful experience of participating in a team sport. There are many children who are not very good competitive athletes, but who may thoroughly enjoy being physically active. So the problem is, how do we design programs that reward physical activity and fitness for these without tying physical fitness to winning, which is all to often the goal of team sports.

The initial and primary benefit of exercise and resistance training for children can help them in developing coordination skills in addition to building strength. We do know that a closely supervised resistance-training program that utilizes concentric-only muscle actions with low resistance and high repetitions significantly improves muscular strength with no adverse effects on muscle, bone, or connective tissues. Concentric-only exercises are exercises that shorten the muscle. An example is the upward motion in a biceps curl.

Below are general guidelines for resistance exercise training and progression for children and adolescents.

Age and Training Considerations

Up to 7 Years
At this age, simply introduce the child to basic exercises with little or no weight. It is important to develop the concept of a training program or session and to teach and emphasize exercise techniques. Also, very gradually progress from body weight calisthenics and partner exercises to lightly resisted exercises. It is important to keep the training volume low. Children are not professional athletes, do not expect them to perform like one.

8-10 Years
Gradually increase the number of exercises. Practice technique in all exercises. Once good technique is learned, a gradual and progressive loading in each exercise can be accomplished. It is important to keep all exercises simple and to slowly increase training volume. Carefully monitor the child’s tolerance to each exercise and its induced stress.

11-13 Years
Teach all basic exercise techniques. You can continue progressive loading of each exercise, but emphasize technique rather than load. Again, do not overload the child and monitor load stress, i.e., load should not be so heavy that the child is groaning in his or her attempt to lift the weight. Introduce more advanced exercises, but use little or no resistance for them.

14-15 Years
Continue gradual progression to more advanced exercises and begin to add sport-specific skills and components. It is very important to emphasize technique as you increase volume.

16+ Years
Graduate your child to entry-level adult programs after all basic and advanced exercises have been taught and the child has good technique and shows a mastery of the exercises through his or her training experience.

As with all training programs, it is important to gradually increase intensity. Technique should always take precedence over weight load. And, obtain a physical check up for your child from a doctor before starting him or her on a training program.