Childhood Obesity - Ursinus Magazine Fall 212

URSINUS Fall 2012

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Childhood Obesity

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rsinus faculty and alumni are among many experts committed to increasing awareness of childhood obesity. They are hard at work creating public school exercise programs, conducting diabetes research, formulating nutrition plans and educating the public about how to keep children healthy. As a vibrant part of a global network of leaders, they are committed to fighting this growing epidemic one healthy step at a time.

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Ursinus Alumni and Faculty Work to Bring Attention to Childhood Obesity

By Ellen Cosgrove Labrecque 1995 and Kathryn Campbell

It was 2001 and Jennifer Skye (Laidlaw) Donovan 1995 had been living in Houston, Texas, for only two weeks when she read an astounding article in the local newspaper. Houston was considered the fattest city in the United States.

preventable with a healthy lifestyle. It had such an impact on me, it made me call the childhood medical center in the area and ask if there was any way I could volunteer my time with overweight kids.”

“According to the article, the average age of a type 2 diabetic, which used to be called age onset diabetes, was just 13. “I couldn’t believe people this young were getting a disease that is mostly

Donovan graduated from Ursinus with a degree in Chemistry and earned her Ph.D. in Biomedical Science and Biophysics at Albert Einstein College of Medicine in the Bronx. While at Einstein, fall 2012 Page 13

Donovan studied diabetes type 2 in a lab setting, so her research on obesity was on the cellular level. Although she enjoyed the intellectual challenge her lab work entailed, Donovan didn’t feel like she was making enough of a difference. She had moved to Houston with the intent of eventually working in a neurological rehabilitation center for people with spinal cord injuries and was doing her post-doctoral work, as well as getting her masters in physical therapy at Texas Woman’s University. But once she read

this article, Donovan shifted her career goals.

When she called the hospital that day, she was put in touch with a doctor working with obese children with diabetes. With the help of the doctor, Donovan was given the green light to begin a grassroots exercise program. Every weekend for five hours, Donovan volunteered her time. She exercised with them, took them on field trips and taught them about healthy nutrition and portion control.

Dr. Christina Wee’s research in obesity focuses on questions of particular relevance to public health and primary care. She works to understand racial and ethnic differences in the costs and health outcomes of obesity and to identify and address the stigma associated with obesity, particularly as it relates to disparities in health care and in medical decision-making.

One of the goals of her research is to help guide primary care physicians in managing obesity.

impacts of obesity Dr. Christina Wee 1989 is Associate Professor of Medicine at Harvard Medical School and Associate Director for Research in the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center, a major teaching hospital of Harvard Medical School. Part of Dr. Wee’s research looks at the role of race and gender in the negative impact of obesity.

“There are populations in which being overweight may be more culturally normative, and this may affect how individuals value losing weight and the treatment risks they are willing to take,” says Dr. Wee, who is also director the Division's Health Services and Behavioral Research Program in Obesity, and Co-Director of the Harvard-wide General Medicine Faculty Development Fellowship Program. She is currently studying how patients with obesity make decisions about whether to undergo weight loss surgery, a surgery which has its risks.

Cases of obesity began to rise in the 1980s and 1990s with changes in lifestyle that resulted from society's increased reliance on technology, people eating more processed foods and in general living a more sedentary lifestyle, says Wee. “Kids now have access to more technology and physical activity has decreased,” she says. The marketing of food also plays a role. “From an economic point of view, it doesn’t makes sense for many families not to ‘supersize it’ if you have a limited income,” she says. “I don’t think anybody chooses to be overweight,” says Wee. “Our weight is a product of our genetic makeup, our environment, and the choices we make in the context of that environment.” Social and economic challenges limit those choices, she says, and those factors often make it more difficult for some people to fight obesity.

Wee’s research includes looking at stigma and the ways in which obese people are judged by society. “We tend to look at a person with obesity differently than someone with other health conditions (e.g.) cancer,” says Wee. “Society tends to blame people who are overweight for their condition. We all have personal choice, but the current physical environment makes it difficult for us to make good choices.”

Obesity, she says, has the greatest impact on populations of people who have less ability to make choices in their work and home. “I am optimistic in the sense corporations like McDonalds are taking more responsibility for how their marketing strategies are affecting obesity,” says Wee. “For example, apples now come with some meals and they have reduced the portion of French fries.”

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“We had to do what I call tricky exercise with these kids,” Donovan says. “All of the kids were obese and uncomfortable doing straight-up exercising. So what I did with them was vigorous exercise through playing. We did relay races and played games like capture the flag. The only criteria for my games were that nobody was ever standing around. They were always moving.”

in the Department of Physical Therapy. In addition to teaching classes, she also runs the wellness program at Marymount. She organizes walks on campus, supervises the running club and hires the yoga and fitness instructors. Most importantly, she conducts numerous programs and studies in the Arlington County school district to encourage healthy lifestyles for kids.

Donovan worked with the Houston kids for two years while completing her physical therapy degree, and in that time she became hooked on helping children grow healthier for life.

“Skye’s research in childhood obesity is elegant in its simplicity,” says Dr. Julie Ries, a physical therapist and associate professor at Marymount. “She is working to demonstrate that if you make fitness activities fun, make recess physical, empower kids to make good choices about their nutrition and fitness, all of these things can have a positive impact. At some point, Michelle Obama is going to realize that she has an incredible resource right here, practically in her own backyard, who shares intense passion toward her cause.”

“I know lack of exercise is only one part of the puzzle when you talk about combating childhood obesity,” she says. “But it is the part I have the most expertise to try and tackle.”

When Professor of Exercise and Sport Science Laura Borsdorf was a young girl, there were no team sports for women. “I was a kid who hated physical education,” admits Borsdorf, trim and energetic. “I thought I could do it better.” Maybe that is why she is so passionate about educating children and adults about the benefits of staying healthy and fit.

“The obesity rate continues to climb, we have to get their attention at a younger age,” she says. “When you see diabetes and high blood pressure in children – that’s pretty scary.” Borsdorf stresses the five components of health-related fitness: cardiovascular fitness, flexibility, muscular strength, muscular endurance and body composition. She recently edited Physical Best Activity Guide, a text for teachers of elementary physical education. While writing the book, she says, contributors “had a hard time finding kids who were a healthy size.”

For Donovan, the numerous grants and honors she has received for her programs have helped to fund the equipment and the scientific research. She has been honored by the WNBA’s Washington Mystic team, sits on the executive committee of the Arlington County Childhood Anti-obesity Campaign and has received grants from the Boeing Foundation and the Parks and Recreation Department of Arlington County.

“Skye is such a strong advocate for children’s health,” says Michele Gregory, health promotion manager of the Parks and Recreation Department. “She also has such a warm, demonstrative personality that the kids just want to get out there on the playground with her and get moving.” Donovan and her team visit Continued on p.17

Professor of Exercise and Sport Science Laura Borsdorf wants people to know that staying fit should be fun.

This July, despite two hard falls while training on her bicycle, Borsdorf took part in the Capitol to Capitol One Ride to bring attention to childhood obesity. All the proceeds went to fight the disease. She is convinced educators can make physical education fun. She hopes people will keep searching until they find their niche. “We have to get people to believe that they can take charge of their health,” she says.

The answer does not have to be hard or tedious, says Borsdorf. It can actually be fun. Whether it’s Geocaching or Frisbee, parents and educators must discover ways to inspire and engage children to keep moving. “Everyone needs to find a different level, and find their own play,” she says. “This is a hard sell because it is not about being the best – it is about being healthy.” The risks of ignoring it are too great.

Donovan agrees. In Arlington, Va., she is now an assistant professor at Marymount University

Borsdorf secured a $125,000 Center for Disease grant in conjunction with the PA Department of Education to develop and disseminate programs and curriculum geared at increasing physical activity and decrease obesity and other hypokinetic diseases within the PA K-12 schools. As President of the PA Association of Health, Physical Education and Dance (PSAHPERD), she developed and implemented “Tools for Teachers Workshops” that helps teachers learn how to utilize technology and the newest resources available in their programs. fall 2012 Page 15

Pathway to Prevention

Teaching the Teachers

“We need to have children who are at risk for the development of obesity participate in activities such as swimming, hiking, biking or other activities that they find enjoyable. Ursinus students are learning how to instruct children and athletes how much to eat and when to eat before and after activity.”

- Pam Chlad, Associate Professor, Exercise and Sport Science “Part of nutrition education at Ursinus is to teach prevention of obesity in children which will lead to a healthier adult weight and lifestyle,” says Pam Chlad, Associate Professor in Exercise and Sport Science and the Head Athletic Trainer for Intercollegiate Sports.

“Adults need an education on proper physiological ways to improve health through better nutrition and effective exercise programs,” says Chlad, a Registered Nurse, who teaches nutrition at Ursinus. “If adults are better informed, it will help in the prevention of childhood obesity.”

“One of the major areas for obesity prevention is to become aware of times during development when we tend to create more fat cells,” she says. “The first year of life is critical in the prevention of fat cell development and throughout childhood and adolescence, it is also important. If children can maintain normal fat cell volume, there will be less development in the number of cells, which helps to prevent obesity. We can shrink fat cells which fill when we store fat, but we really can’t decrease the number of cells that develop in childhood from excessive caloric intake and inactivity.”

Ursinus students are more aware of the health concerns which can occur from obesity.

Students who take the Ursinus nutrition classes use several computer programs to help evaluate a diet and create new nutritional programs that offer better food balance between carbohydrates, fats and proteins.

“They can design a nutritional plan to help children during their activities have the correct carbohydrate and protein content in the diet for better energy storage to help them when participating in activities,” says Chlad. “Students learn how to instruct children and athletes how much to eat and when to eat before and after activity. This can help prevent fatigue and restore energy so children can participate more effectively and gain muscle mass which helps to prevent obesity.”

The way to teach nutrition has changed over the years, she says. Classes discuss the potential influence of parents, teachers and caregivers on the prevention of obesity by being good role models.

“Parents need to help children become involved in making better food choices and learning how to shop and prepare foods,” she says. “Making good food choices and learning how to improve their nutritional and exercise needs are necessary so that children will learn from them and share the responsibility for creating healthier lifestyles.”

Ursinus students are more aware of the health concerns which can occur from obesity, says Chlad. “I think there is more emphasis on evaluation of fad diets and how they have not impacted the obesity epidemic,” she says. “They realize how difficult it becomes to alter our weight and lose fat in adulthood so prevention is so needed during childhood. Students evaluate body composition instead of weight loss when evaluating the effectiveness of a diet program or exercise program.”

Teachers and parents need to evaluate how to make activity available and convenient for all children. “We need to have children who are at risk for the development of obesity participate in activities such as swimming, hiking, biking or other activities that they find enjoyable,” says Chlad. “Children who are overweight can find it difficult to play organized sports. It is difficult for working parents to find time during the week to participate in recreational activities with their children. We need to find programs in our recreation centers and afterschool programs to help children have access to many different types of large muscle and aerobic activities.”

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Continued from p.15

Arlington County schools at recess time and engage students in vigorous activity similar to the ones she did in Houston. While the kids do the games, they wear accelerometers, which are like pedometers, but measure movement in three dimensions instead of one. The kids wear the devices at recess when Donovan’s team is there, and they wear them when they are on their own. In her most recent study, Donovan discovered that the accelerometer readings indicated that the level of children’s activity on average increased from seven percent when she was not there, to 40.5 percent when she was running the games.

“Around 10 years old is when recess stops being cool,” she says. “So when I am not there, the kids sit around a lot, especially the girls.”

Donovan is now in the midst of expanding her program by creating a resource website, called “Go Play,” that will include instructions for the games as well as how to train staff to run these games. Additionally, she is working on putting together kits to give to schools that will include basic equipment like jerseys, plastic markers, and balls.

“We want this to become a sustainable effort,“ says Donovan. “The more schools that are able to run these programs on their own, the happier I will be, and the healthier the kids will be.”

“Getting parents to really think through the long-term consequences of today’s children’s sedentary lifestyles is one of the keys to reducing childhood obesity and restoring outdoor play.”

Gabrielle F. Principe, Associate Professor and Chair of Department of Psychology

SNACKvs.ATTACK GOOD CHOICES How one Ursinus mom has educated her kids about healthy eating habits

Raising healthy and active kids is more of a challenge than ever before. Parents are forced to combat a constant stream of junk food advertisements, not enough recess and physical education time, too much television and video games, and even the lack of sidewalks in neighborhoods.

Jean (Figuli) Anderson 1993 has faced these challenges and then some raising her three boys; Jeffrey, 16, Matthew, 14 and Michael, 8. Anderson, an Exercise and Sport Science major at Ursinus who also was a student athlete trainer for the football and basketball teams, is also an avid runner. Her husband, Jeff Anderson, is a colonel in the United States Army and the family has been stationed in Germany, Alaska and currently Fort Riley, Kansas. Keeping her family healthy and active is a priority. So far, she has managed to win the battle against snacks and inactivity with her own kids.

“I think the hardest thing about raising healthy, active kids is teaching them good choices,” says Anderson. “We can’t be with our kids every second of the day. They can choose to eat dessert once in a while, but just one cupcake, instead of three. They can have a couple of chips with their sandwich, but they don’t need to eat the whole bag. When my boys do treat themselves when I’m not around, I hope I’ve taught them to choose the small drink, the small fries.”

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“If we teach them how to make good choices instead – from exercising to choosing the right foods – our kids will make the right decisions in the end. It’s all about the healthy-living education.”

- Jean (Figuli) Anderson 1993

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Good decision-making is also about teaching them to choose to go outside instead of watching television and play video games. “During the school year, we don’t allow them to play video games during the week,” she says. “We let them play video games on the weekend, but they don’t overdo it. I think this is the message that gets lost on parents. If we deny our kids everything, then when they are out of our eyesight, they’ll go wild. But if we teach them how to make good choices instead – from exercising to choosing the right foods – our kids will make the right decisions in the end. It’s all about the healthy-living education.” fall 2012 Page 17

Donovan is also starting to form relationships with physicians, psychologists and nutritionists in Arlington County to see how she can include them in her programs — from creating diet plans to educating family members along with the students.

“It’s not going to be just one entity that fixes the problem,” she says. “The overall solution has to come from every different side and every different angle. But in the meantime, I’ll continue to do my part.”

The disconnect between what scientists know and how we rear and educate children is what motivated Gabrielle F. Principe, Associate Professor and Chair Department of Psychology, to write her book Your Brain on Childhood: The Unexpected Side Effects of

Instilling Healthy Routines Pediatric obesity is an imbalance of calorie intake and caloric needs

Classrooms, Ballparks, Family Rooms, and the Minivan.

One of these disconnects, says Principe, is that we know that unstructured outdoor play is good for children’s brains and bodies, yet this once common feature of childhood has almost disappeared from the lives of most children today.

“Today’s children spend an average of less than 30 minutes a week in free outdoor play. However, the typical elementary school age child spends more than 40 hours a week with high technology, like computers, smart phones, and videogames – a virtual fulltime job,” she says.

It’s clear, she says, that children’s diets play a major role in child-

While obesity has been referred to as an epidemic, it might now be considered a pandemic given the extent of the problem across the developed world, and now it is emerging in less developed countries, says Wendy Slusser, MD, MS, FAAP, Associate Clinical Professor UCLA Schools of Medicine and Public Health. There are many contributing factors to this change in children’s health. “The causes of obesity include genes, inter-environment, sleep and eating patterns, calories, screen time and stress,” says Slusser, a fellow of the American Academy of Pediatrics.

Dr. Slusser is currently the principal investigator on the Prevention of Childhood Overweight through Parent Training Intervention Project, focused on low-income preschool children and their parents, and other projects.

The risks for being an overweight child are profound. “The short-term risks are poor emotional health, poor school performance, musculoskeletal complaints and gastrointestinal complaints,” she says. “The long-term are hypertension, diabetes type 2, heart disease, musculoskeletal problems, poor emotional health, polycystic ovary disease and posJennifer Skye (Laidlaw) Donovan 1995 works to help children stay fit. sible infertility.”

One study* determined that if children reduced their caloric consumption by 350 kilocalories per day or compensated by increasing their physical activity – the equivalent to 110-150 minutes of walking per day – that children would return to the mean body weights of the 1970s, says Slusser, Medical Director for UCLA FIT for Healthy Weight Program Mattel Children’s Hospital UCLA. So what other strategies will help schools, doctors, and most importantly, families to help change this trend? “If you have to summarize the simplest approach it would be to instill healthy routines,” says Slusser. “This includes planning the day to allow enough time to eat breakfast in the morning, including quality PE in the school day, allowing for sufficient time to eat lunch in the school day, eating a dinner at home with your family and the television off and going to bed at an hour that ensures the child gets enough sleep (around 9-10 hours depending on the age of the child).” *From: Swinburn B, Sacks G, Ravussin E. Increased food energy supply is more than sufficient to explain the US epidemic of obesity. Am J Clin Nutr. December 2009 90 (6) 1453-1456.

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hood obesity, but so does the mostly indoor and sedentary lifestyles of many of today’s children. Principe says in the 1960s, less than five percent of American children were obese. Childhood obesity has more than quadrupled since then.

“This worrisome change puts children at a greater risk of developing hypertension, diabetes, and heart disease than ever,” she says.

“Obesity is the result of actions that, one at a time (playing videogames, eating a high caloric snack), are not particularly danger-

ous, but that repeated over months and years can have harmful consequences. However, we have a hard time seeing the negative effects of things that don’t immediately cause harm, even if we know the long-term risks. So we don’t fear that the couch and the TV set might cause obesity in our children because we don’t see it happening. Getting parents to really think through the long-term consequences of today’s children’s sedentary lifestyles is one of the keys to reducing childhood obesity and restoring outdoor play.”

BMI not just a number

Obesity is not just about the BMI (Body Mass Index) number, says Dr. Alexander Onopchenko 1979. “It is about how the extra weight adversely affects health and how losing the weight positively diminishes or prevents the co-morbid disease burden,” he says. “Other evidence of obesity as a disease is that it has all the etiological components of any other disease with a genetic predisposition, physiological derangements that occur due to the enlarging fat mass and environmental components that are interacting with the genetic predisposition.”

Thirty-seven and a half percent of the adult American population is obese. “Some good news may be that it seems that obesity rates may be leveling off,” he says. “The bad news is that the rates are exceedingly higher than previous historically observed. Each subsequent generation seems to be increasingly disproportionately affected by this epidemic.”

Onopchenko is a bariatric surgeon performing laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy and Lap-Band placement. His patients must meet the NIH criteria of the definition of morbid obesity (BMI=40 or BMI 35-39.9 with medical co-morbidities attributable to obesity). “The average patient of mine has been dieting for most of their lives, most with some degree of success, only to regain their weight over the longer term,” he says. Most of his patients are in the prime of their lives. “It makes it a very rewarding practice to be able to impact so positively and change the quality and even quantity of my patients' lives,” he says.

According to Onopchenko, there are many contributing factors to this epidemic, some explainable, some not. “Humans have developed as calorie conserving oraganisms. We consume calories and then guard a determined weight set point with extremely complex brain to gut and gut to brain hormonal pathways that have multiple feedback loops that are very difficult to permanently alter as anyone trying to lose weight on a diet will attest. Combine this with a progressively sedentary lifestyle, and that combination of physiological and environmental influences are all contributing factors.”

The root of the problem? “Our physical evolution is not occurring as fast as our progressively sedentary lifestyles aided by exploding technological advances,” says Onopchenko. “This is an oversimplification but what we eat, how much we eat and how little we physically do combined with genetic predisposition has produced the epidemic. Other less obvious but more profound etiological factors may yet be identified and clarified, such as the use of hormones and genetic manipulation of our food supply. The pervasiveness of high fructose corn syrup as an additive to food itself may play a significant role.”

Other factors have contributed to the rise in obesity. “Breast-feeding has been linked to lower rates of childhood obesity and though breast feeding rates are recently increasing, it can be difficult for fully employed mothers and single parents. This begins a downward spiral in nutrition for children,” Onopchenko says. “A peek at the average ‘kid's menu’ of chicken fingers, macaroni and cheese, hamburgers and hot dogs all washed down with a soft drink deliver huge amounts of calories, mostly of carbohydrates and fats to our toddlers and children. Once in school, school menus have notoriously been as bad. Combine that with the amount of ‘screen time’, sitting and viewing a screen whether it is a TV, computer, hand held electronic game, compared to physical activity and it is little wonder that children are disproportionately affected by this disease.”

Dr. Alexander Onopchenko 1979 MD,FACS, FASMBS founded the Center for Surgical Weight Loss and Wellness at Atlanticare, an American Society for Metabolic and Bariatric Surgery designated center of excellence. He has performed over 1,700 bariatric operations and is board certified by the American Board of Bariatric Medicine as a medical bariatrician. fall 2012 Page 19