Childhood obesity in developed nations is not a new problem. It has been slowly worsening over the past century but in the last decade it has reached truly epic proportions. It is the socio-cultural health problem of our times and now supercedes cigarettes as the number one health issue of developed nations.

As with most medical problems the cause of childhood obesity is multifactorial and the solution requires addressing each factor.
These factors are: A) the human instinctual desire to feed their children.
B) The evolution of our eating preferences to food with higher caloric content and D) the erosion of physical activity as the principle leisure activity of childhood.

Human beings will do everything in their power to feed their children. Thousands of years ago that took a lot of hard work. There was no refined floor or sugar. But humanity's desire to feed its children has evolved into a huge industry, an overreaction to our primitive survival instinct. Snickers, Twinkies, Yodels, Little Debbie, Ice cream, Birthday cakes ad nauseam! None of these are essential foodstuffs. All are highly caloric. Many are used as rewards.
Childhood obesity is primarily a parenting problem. In this modern age of plentiful high calorie foods parents have to learn to reprogram their child protection instincts away from the- starving- children- in- China- depression Era thinking to “ If I feed my kids to much they will die young of a heart attack.”


Dr Stein’s Rules for Parental Dietary Control of Children

1) Do not reward children with food
2) Avoid all refined carbohydrates, whole grain stuff only
3) Avoid high fat foods
4) No deserts except on special occasions.
5) Fruit for snacks
6) After age 2 switch to 1% or skim milk.
7) Do not force children to finish what is on their plates. When they are done let them be done.
    Avoid second helpings
8) Do not argue over what a child eats. If the kid doesn’t like broccoli don’t feed him or her broccoli.
9) A daily vitamin never hurts
10) For long duration/high output activities like hiking, cycling and cross-country skiing carry energy bars
     and rehydration fluid like Gatoraid
11) Avoid high calorie drinks like regular soda and fruit juice. Diet soda and products like Crystal light
     are just fine. Contrary to popular myth, Equal or Nutrasweet are absolutely no danger to children
     who are not afflicted with PKU (phenylketonuria)
12) Unless a child is physically or psychologically ill or being mistreated by its caretakers,
     THERE IS NO SUCH THING AS A CHILD THAT IS TOO SKINNY. Parents make skinny children fat adults.
     Anorexia Nervosa and Bulimia can result in severe malnutrition but they occur in less then 1% of the pediatric
     population while obesity affects over 30% of children.


Physical Activity in Childhood

The other half of the childhood obesity problem begins just before WWII with the proliferation of radio, which –inevitably- spawned TV and laid the groundwork for a technology explosion which popularized, and made affordable, the personal home computer. As most parents know, the minds of children run in hyper drive. They have a need for what psychologists call stimulus variation. Prior to WWII that stimulus variation came from outdoor sports and rough housing. Many children still helped with chores on the farm - even in suburbia.
Slowly, physical activity became replaced by sedentary activities such as watching TV then computer games and now the lure of the internet and computer communication. Worse, many associate food with these activities e.g. popcorn with movies and the like. The end result is that children are less active and eat more.

Human beings were designed for physical activity. For hundreds of thousands of years their lives depended on being physically capable. Those that were not, died young. Modern medicine knows for a fact that exercisers have 1/3 the heart attack rate of sedentary people. Exercisers have lower rates of diabetes, osteoporosis and even certain cancers. They also maintain much higher levels of functional capability as they age. (I have 80 year old patients that still ski!) Parents need to subsidize physical activity in their children by exercising with them in addition to supporting the activity they share with their friends. Jogging, hiking, cycling, mountain biking, swimming, skiing are all high output aerobic activities that can be shared by families. Adults stay in shape and children learn that exercise is an integral part of life.

Schools need to reinforce their physical activity programs and modernize their cafeteria menus keeping an eye on fat content, refined carbohydrates and calorie load.

In the home, TV and nonacademic computer work need to be limited or allowed only after certain requirements- like the day’s exercise are met. Food should be divorced from both TV watching and computer activity.

Parents need to sit down together with their children and create a family plan integrating diet and exercise. Then, they need to approach their children in a unified no nonsense way establishing the rules and pledging to stick to them. Many of us adults will have to overcome our own demons in the process perhaps the most difficult aspect of the whole problem. It is a certain fact that fat adults make fat children.

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