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Posted: Wednesday, February 1, 2012 12:30 am | Updated: 4:07 pm, Wed Feb 1, 2012.

There’s an epidemic going on right now in children’s health, and you’ve no doubt heard the news reports — childhood obesity is at an all-time high.

Physicians and others have been sounding the alarm for several years now, yet the trend continues.

Dr. Burt Bromberg, a pediatric cardiologist with Mercy Children’s Hospital in Creve Coeur, has serious concerns, not just about what this means for children’s health presently, but in coming decades as they become adults.

The “epidemic” of childhood obesity being seen now is foreshadowing a far greater crisis that will come in 20 to 30 years, he said, when these children are adults and are diagnosed with heart disease.

“As a pediatric cardiologist, I see mostly kids with structural heart defects or electrical disorders,” said Dr. Bromberg, “but the number of kids with these pales in comparison with the ones who are brewing heart disease.

“If you look at the people who develop heart disease as adults there are a number of risk factors: 1. weight or body mass index (BMI); 2. hypertension or high blood pressure; 3. cigarette smoking; and 4. adverse parameters in their lipid panel, or high LDL cholesterol and high triglycerides.

Dr. Bromberg will be the keynote speaker at Mercy Hospital Washington’s annual Heart to Heart Fair being held this Saturday, Feb. 4, from 10 a.m. to 2 p.m. at the hospital. Admission is free.

Dr. Bromberg will speak about “The Coming Epidemic of Heart Disease in Children — What You Can Do to Combat It.” His presentation will include a question and answer period.

The overall theme for the heart fair is “Heart Health for All Ages.” Heart health in children is a growing concern as more children are diagnosed with risk factors for heart disease.

See the sidebar story for complete details on the Heart to Heart Fair.

Heart Disease Is Progressive

Dr. Bromberg said the evidence that childhood obesity is laying tracks for adult heart disease is made clear in the results of the Bogalusa Heart Study, a longitudinal study that began tracking some 14,000 children living in a small community in Louisiana in the early 1970s.

The children were checked annually on various parameters, including blood pressure, diet, whether or not they smoked and how much physical activity they engaged in, said Dr. Bromberg. Along the way, some of the children died for various reasons, and the researchers conducted autopsies to inspect their aorta and coronary arteries, taking into consideration whether or not the patient had any of the risk factors for heart disease.

In the end, what they found surprised them, said Dr. Bromberg.

“They found the fatty streaks that are the beginning of heart disease in 2 percent of the patients who had died and had no risk factors for heart disease. And they found them in 12 percent of those who had three or four risk factors . . . that’s six times as high.”

The fact that the beginning stages of heart disease could be present in children so young was eye-opening, said Dr. Bromberg, but added to that was evidence that these fatty streaks got worse as the children aged.

Over half of the children had these fatty streaks by the time they were 21 and 70 percent had them by the time they were 26 to 39 years old.

The message parents and caregivers of young children should take from these results is that heart disease starts young and is progressive, said Dr. Bromberg. It builds over time.

“And the risk factors only increase the severity of it,” he said.

Genetics Argument Doesn’t Wash

While genetics may account for some of the cases of childhood obesity and the presence of fatty streaks, Dr. Bromberg said as a whole it doesn’t explain the marked increase in these conditions over the past 30 years.

“In the 1990s, 10 states reported a prevalence of obesity in 10 percent of adults,” he said.

“By 2000, there wasn’t one state that had an obesity incidence of less than 10 percent, and in 23 states it was 20-24 percent, but no state had (incidence) greater than 25 percent.

“In 2010, there was no state with obesity incidence less than 20 percent; 36 states had (incidence) greater than 25 percent, and of those 36, 12 states, including Missouri, had an incidence of greater than 30 percent.”

Similar increases are seen in the number of children who are obese, said Dr. Bromberg. He cited a survey from 1976-’80 that found the incidence of obesity in children ages 6 to 19 was 5 percent.

By 1988-’94, that number had increased to 12 percent; in 2000 it was up to 15 percent; and the most recent data, from 2007, puts the number of children who are obese at 19 percent.

Tracks Into Adulthood

One of the reasons the increasing number of children who are obese is so alarming and of such concern is that research shows obesity in childhood tracks into adulthood, said Dr. Bromberg.

“Eighty percent of kids who are obese will be obese as adults,” he said, noting there also is some evidence that once people become overweight their bodies experience metabolic changes that make it harder to lose the weight.

“Their body may not burn as many calories at rest as it did before and there may be hormonal changes . . . that make them feel hungry more often,” he said.

Plus any behavorial or emotional issues that led to the person overeating in the first place may still be present, so “it’s like the horse is out of the barn,” Dr. Bromberg remarked.

What this means is that the ramifications of childhood obesity are far-reaching and affect all of us.

“If you think our problem with heart disease now is a problem, imagine what it will be like in 20 or 30 years,” Dr. Bromberg said.

The good news, he stressed, is that there is a very clear solution.

Calories In, Calories Out

The secret to keeping weight in check is really no secret at all, said Dr. Bromberg. It’s basic math.

“It’s calories in and calories out.”

The more calories you take in, the more you have to burn off in physical activity, or else you gain weight, he explained.

Right now, too many people are eating unhealthy foods and then living a sedentary lifestyle — sitting around watching TV, working on a computer and playing digital games on their handheld devices that require little to no movement.

“It isn’t just that we don’t burn calories, it is that we eat while we watch (TV), usually chips or cookies or ice cream,” said Dr. Bromberg. “We see commercials for (food) and it makes us hungry.”

So the solution isn’t just a better diet, although that is key, he said. It’s also about having enough activities for young people, which Dr. Bromberg sees as a community responsibility.

“Kids need at least 60 minutes of activity every day, and many schools today only have gym class two days a week,” he commented.

“And as kids get older, the sports teams they played on aren’t available to them anymore because they don’t make the team. Why aren’t there recreational (sports) leagues for kids who may not be able to make the school team?” Dr. Bromberg asked.

“And what (foods) are kids being served in school? I don’t think it’s unreasonable not to have soft drinks and candy bars available to them . . . but part of the problem is there are too many people or companies that have a stake in continuing these problems.”

What Parents Can Do

There are a number of ways parents can take charge of this situation, said Dr. Bromberg, beginning when children are very young — even newborn, by watching their own attitude about food and eating.

“Breast fed babies are less prone to be overweight,” he said, explaining there is no concern over how many ounces a baby drank because it can’t be measured.

Yet babies who are fed formula in a bottle where it can be measured may be encouraged to “finish the bottle,” even when they aren’t hungry for more.

When children move to the table for their meals, Dr. Bromberg stressed the importance of introducing a variety of healthy foods at an early age.

“Everyone should now be aware of the importance of a balanced diet – four to five fruits and vegetable servings a day, whole wheat bread and grains, 1 percent milk.

“The problem I frequently encounter is the parent who says, ‘He just won’t eat vegetables; he only likes chocolate milk; he will only drink sodas.’ These are learned patterns of behavior,” said Dr. Bromberg. “The reason Indians eat a largely vegetarian diet, that Chinese eat rice dishes with vegetables and spices, is that these are the foods with which they grew up.

“Parents need to be firm with their children from the time they begin baby food onward, continuously exposing and re-exposing them to healthy foods.

“The average exposures a baby needs to begin to accept a new taste is five to six times. Once they acquire a taste for fruits, vegetables, whole grain cereals, etc., you don’t have to battle them when they are 10 or 15 years old to change their eating patterns.”

Next, parents need to be cautious about placing their young children in front of the TV and, for older children, allowing them unlimited “screen time,” which includes TV, computers and any digital device.

“For children under 2 years old, there is no reason to have them in front of a TV. There is no educational benefit,” said Dr. Bromberg. “And beyond 2 years, the recommendation is two hours or less a day.”

Knowing much of the screen time children experience is a result of parents working or trying to keep a child occupied while they complete a few household chores, Dr. Bromberg suggests they look outside the home for solutions.

“So this is a situation where a community can look around and say, ‘We need a place where kids can do recreational things safely’ . . . so they’re not just walled off playing video games or holed up in the basement.”

Dr. Bromberg also puts pediatricians on the hook too.

“They need to be tracking a child’s weight from age 2 on,” he remarked.

Parents, teachers and community leaders who are looking for ways they can turn the tide on childhood obesity can find solutions online too. There’s more help out there than people may realize.

Dr. Bromberg suggested these websites:

• http://www.letsmove.gov, a portal to First Lady Michelle Obama’s initiative to address childhood obesity.

• http://www.choosemyplate.gov, where topics include sample meal plans, dietary guidelines and eating on a budget.

Posted in Feature stories on Wednesday, February 1, 2012 12:30 am. Updated: 4:07 pm.

Read more:
‘The Coming Epidemic’

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