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A Big Fat Problem
From basic science to strength-training to long-term weight-loss programs, UK researchers are working to help our kids go from fat to fit

by Jeff Worley

Photo of overweight boy slumped over dangling feet into poolOur country's children are fat. No, make that FAT. And unless you've been living in a cave, you know this.

The Surgeon General and the Centers for Disease Control and Prevention are now using the terms "epidemic" and "crisis" to describe our children's collective waistline. Our problem is immense: our problem is immensity.

In June, Time magazine ran a 27-page article, titled "America's Obesity Crisis," citing a blizzard of depressing statistics for both adults and children. And though the numbers for adults are shocking—two-thirds of U.S. adults are officially overweight and about half of those have moved on to full-blown obesity—the obesity numbers for adolescents and children are mind-numbing.

Twenty years ago in the United States, 5 percent of kids were overweight; today 15 percent are and another 15 percent are headed that way. According to the American Obesity Association, approximately 30 percent of children (ages 6 to 11) in this country are overweight, and among adolescents (ages 12 to 19), 30 percent are overweight, and nearly 16 percent are obese, as determined by the body mass index percentile. The prevalence of obesity has quadrupled in the last 25 years among both boys and girls.

In Kentucky, things are even worse. As reported by Jim Warren and Mary Meehan in a Lexington Herald-Leader article last June, Kentucky became the fourth fattest state in the nation this year. Nearly a quarter of Kentucky's adults pack around 30 or more excess pounds, and a quarter of Kentucky's pre-schoolers—and almost half its sixth graders—are overweight, or at risk of becoming so. More than 14.5 percent of Kentucky high schoolers are overweight, compared with 10.5 percent nationwide, according to the Kentucky Obesity Epidemic 2004 report, published by the Kentucky Department for Public Health. Kentucky, the report concluded, is raising the most unfit generation in the commonwealth's history.

What is Body Mass Index?

To find your BMI, divide your weight in pounds by your height in inches. Divide that number by your height in inches again, then multiply that number by 703.

BMI Status
Below 18.5 Underweight
18.5-24.9 Normal
25.0-29.9 Overweight
30.0-39.9 Obese
40 and above Morbidly Obese

Note: Body mass index is a more accurate measurement than weight because it takes into account that short people tend to weigh less than tall people. But it's not perfect: The BMI of extremely muscular athletes is often in the obese range.

Our kids weren't always so fat. What happened?

"The statistics out there for kids and adolescents are just frightening," says James Anderson, longtime professor of internal medicine at the University of Kentucky and a weight-loss expert. "I think one major factor contributing to the explosion of obesity in children in this country is the ready availability of inexpensive, tasty foods. You know, you go into homes and you see snack food all over. You see candy. You see chips. You see crackers. You see all these high-fat foods that are just hard to get away from."

In a sense, we're the victims of our own abundance. Food, both nutritious and non-nutritious, falls easily into our grocery carts and is literally at our fingertips. All we have to do is punch up a pizza number, and minutes later someone's at the door with a steaming pie.

Secondly, Anderson says, there has been a systematic reduction in physical activity. Kids rarely walk to school anymore—parents will drive their kids a half-block with the excuse that walking isn't safe. Add to this the fact, as reported by Time, that in 1969, 80 percent of kids played sports every day; today 20 percent do. In most gym classes in our public schools, kids are aerobically active for just three minutes. If they have gym at all. In one Lexington public school, some seventh and eighth graders take no gym classes at all.

"The third thing that impacts on the first two factors is the electronic age," Anderson continues. "Children are watching 2 ½ hours of television a day. Teens are on the Internet for hours instant messaging. Then, there are video games. I think these things are the magnets that have contributed to the lack of physical activity and also, of course, these passive activities enhance the appeal of snack food."

But these are children and teens. They live at home under rules made by their parents, right? So, why are kids being allowed to do things that set them on the road to obesity?

Too many parents, directly or tacitly, give their children permission to stay riveted to various screens for long periods of time and to forego exercise, says Sharon Barton, an associate professor of nursing at UK who has worked with school-age children for 25 years. And Barton, an expert in infants' and children's nutrition, has a lot to say about parental permissiveness and how it leads to obesity among kids and teens.

"I've found that in working with children who are overweight or have eating issues, parents often think that children deserve particular food items. They need popsicles. They need ice cream. They need Little Debbie Snack Cakes. One physician I know who works with overweight kids will pull parents aside and say, 'Would you purchase cigarettes and give them to your five-year-old? Well, you're essentially doing the same thing by giving them Little Debbies.'"

Photo of Cody StoneCody Stone, 13, works off excess weight in UK's PEP program. See Cody in action in "A Gym of Their Own."

The problem is not only parental passivity, Anderson says. In addressing the obesity problem, even professionals on children's and teens' health tend to drop the ball.

"Unfortunately, in our current mind-set, we are giving children permission to become obese," says Anderson. "We're so worried about traumatizing them by saying they're overweight. Too many of our 'experts' in children and adolescent behavior and nutrition say, 'Let's just watch. Let's not make a diagnosis right now. Let's just watch.'

"The current authorities, the experts at the NIH and the American Pediatric Society, for example, say, 'Well, if you label a child obese, you may trigger anorexia. You may cause an eating disorder, so let's just not mention it.'" Ignoring the problem, Anderson adds, is no solution because it's fairly easy to predict which obese teens will become obese adults. If a teen is above the 85th percentile on the body mass index profile, that teen has about a 95 percent chance of being an obese adult.

Then there are the schools. Fifty years ago, very few schools around the country had vending machines. If you wanted to have a Coke with lunch, you had to bring it with you from home. Now, flashing like a row of Las Vegas slots, vending machines beckon from the hallways of our schools. And the products in these machines, their allure to a captive audience enhanced by billions of dollars of advertising each year, tend to contain only empty calories that translate into fat.

Schools in particular "have become nutritional disaster areas," says David Ludwig, a Harvard pediatrician who directs the obesity program at Children's Hospital in Boston. "We as a society have abdicated responsibility for teaching kids how to eat right and how to have an active lifestyle." Ludwig's research shows that for every additional daily serving of a soft drink, a child's risk of becoming obese rises 60 percent.

"There are lots of societal factors contributing to obesity, and since children are so vulnerable and change the most rapidly, they are the most visible in our country's obesity explosion," Anderson says.


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For a complete listing of clinical trials at UK, visit the Clinical Research Organization website.