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Clear Choices: Nursing researcher works to reverse tide of childhood obesity, helping families make healthy decisions

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Nine-year-old Martha sits in front of a poster that depicts a single chocolate chip sitting on top of five pounds of grapes. After several weeks participating in a University of Texas at Austin School of Nursing research program on healthy eating and weight management the message is not lost on her. The chocolate chip has the same amount of fat grams as the grapes.

She also is learning about the difference in good and bad cholesterol, the value of drinking eight glasses of water a day and eating smaller portions of food. Martha knows playing outside is better than watching television.

A single chocolate chip has the same amount of fat grams as five pounds of grapes
Children and parents in the study learn about healthy dietary habits, including the amount of fat content in various food products. Five pounds of grapes and a single chocolate chip each have .70 grams of fat. And, one chocolate-covered doughnut has the same grams of fat (21 grams) as 133 oranges.

She even takes time to read a few food labels as she walks down the grocery aisle with her mother.

Learning how to change in order to have a healthier lifestyle is the bottom line in Dr. Diane Tyler’s study on children’s health and weight. It is being conducted at the school’s Children’s Wellness Center in Del Valle and at the Wellness Enhanced Through Lifelong Learning clinic in Hays County.

The children and families served by the clinics are predominantly Hispanic, low-income and medically underserved.

“The number of overweight children has rapidly increased in the past three decades, with 14 million U.S. children overweight and an additional 8.6 million at risk for being overweight,” said Tyler, an associate professor of nursing. “That’s one in three children who are either overweight or at risk for being overweight.”

Among Mexican American children of low-income families, the prevalence is higher. In fact, compared with other racial and ethnic groups, Mexican American children are among the heaviest.

 “Experts agree as to why the obesity epidemic has occurred,” Tyler said. “We haven’t changed genetically, but our lifestyles and the environment have.”

Diane Tyler
As former director of the School of Nursing Children’s Wellness Center, Dr. Diane Tyler began to notice increases in Type 2 (adult onset) diabetes in children in the late 1990s. She believes preventive care with early intervention is the best approach to helping overweight children.

Research initiatives like Tyler’s focus on preventing and treating overweight children. She received funding from the National Institutes of Health to study the effects of a 12-week weight management program on children’s body-mass index, their waist circumference, quality of life, blood pressure, physical fitness, and lipid, insulin and glucose levels.

Her study focuses on reasonable weight-loss goals, physical activity, dietary management—and most important—family involvement.

“I was concerned about Martha,” said her mother, who has eight children at home. “Once we got in the program, I decided I wasn’t going to prepare separate meals for everyone. We are all doing this together.”

Now, she said, Martha is playing baseball, jumping rope, running outside and eating less pizza, chips and cookies and more fruits and vegetables.

“Sometimes when I eat something she doesn’t think is healthy, she tells me not to,” her mother said.

Preventive care with early intervention is the logical approach to helping overweight children, especially because there is evidence that once an individual is obese, it is very difficult to lose and maintain weight loss, Tyler said.

“Given all that is out there—computers, videos, DVDs, fast food, larger food serving sizes—what can we as health providers do to encourage more physical activity and better eating?” she said. “How can we help overweight children and their families make behavior changes in order to have and maintain a healthy weight?”

According to the U.S. Surgeon General, overweight children have a 70 percent chance of becoming overweight or obese adults. This increases to 80 percent if a parent or both are overweight or obese.

“It is commonly known that the average adult gains about one pound a year until he or she is 60 years old,” Tyler said. “So, if you are overweight during childhood, you are likely to have difficulty managing weight as an adult.”

As former director the Children’s Wellness Center, Tyler began to notice increases in Type 2 (adult onset) diabetes in children in the late 1990s.

Participants in the children's health and weight study have their blood pressure checked
Sister and brother Meagan and Matthew, who are participating in the children’s health and weight study, have their blood pressure regularly checked. Nurses also monitor blood cholesterol, triglycerides, insulin and glucose.

“We were beginning to see children as young as 10 years old with health conditions that previously wouldn’t develop until the age of 40 or 50 or later,” she said. “Health care providers are very concerned about the impact of early onset of disease.”

Diabetes is just one of the ill effects of being obese. In turn, persons with diabetes are at risk for strokes, heart disease, blindness, hypertension and kidney failure. Nationwide, there has been an increase in children being diagnosed not only with Type 2 diabetes but sleep apnea, orthopedic problems, liver disease, hypertension and other conditions usually seen only in adult patients.

Tyler has found that most people are concerned about their overweight children once they realize they are overweight.

Children in the weight management study range from 8 to 12 years old. Assessments are made to learn about their medical history, eating and activity patterns and general health-risk status. Weight-related conditions, such as elevated blood pressure and cholesterol levels, have been found in many of the participants.

“We do not label children or use terms, such as ‘obese,’” Tyler said, “but rather emphasize that we are trying to help them grow into a healthy weight so they don’t become overweight adults.”

In this research and in a previous pilot study at the Children’s Wellness Center, Tyler found that few of the overweight children consumed fruits and vegetables and many engaged in only sedentary activities. In the pilot study, it was found that the majority perceived themselves as “big,” wanted to make changes in their body size and wanted family members to participate in making changes with them.

Meagan exercising outside
Meagan is trying to eat healthier and has learned the importance of regular exercise.

Although many were in the very high body mass index percentile, they perceived themselves to be healthy or healthier than others.

“Many people, including Hispanics, will take action only if they perceive their health to be poor and overweight children, especially in low-income populations, may actually be seen as an indicator of good health,” Tyler said.

She concedes that this perception of being healthy in the presence of multiple indicators of poor health may pose challenges to successful intervention.

To help children in the study learn the value of “moving whenever you can” they are given pedometers to wear.  Jump ropes, sport balls and water bottles also are handed out and the children fill out an activity log, which includes pedometer time and time viewing television and videos.

Tyler said children should try to get at least 60 minutes of moderate physical activity on most days.

Playing football, decreasing sugar drinks and drinking eight glasses of water a day have become part of 12-year-old Angel’s routine.  He has been in the program for three months.

Liz White
Liz White received her master’s degree in nursing last year and now works with Diane Tyler on the research. She says some families are still eating too much fast food, but others are trying hard to make improvements.

“Since Angel has the same body build as his father and grandfather, I became worried,” said his mother, Lorena. “Now, we are learning what we need to do—about different kinds of fats, what cooking oils are better to use and many other things.”

Tyler is getting a range of results from those who have been in the study for a few months.

“Some families seem to have made no change at all,” said Liz White, who received her master’s degree in nursing last year and is now working with Tyler. “The families say they want to make changes, but when I do food frequency surveys, it seems like they are still eating lots of fast food. And, of course, it follows that those kids aren’t losing weight and in some instances are gaining weight.”

But, said White, there are other children who are trying hard to at least make changes and improvements are being seen.  

“These kids may not lose a lot of weight,” White said, “but they are at least maintaining the same weight while they continue to grow, which means their body mass index is going down.” 

Lab results for these children also are improving, White said.

“We monitor blood cholesterol, triglycerides, insulin and glucose,” she said, “and often it seems that we see those improve before we see improvement in the child’s weight.”

Changes in parent’s marital status, lost jobs and income problems make it even more challenging for parents who want to make modifications in what their child eats, said White.

“Unfortunately,” she said, “there appears to be more family chaos with these particular families.”

And sometimes, said White, the mother is more concerned about the child’s weight than the father “so there is some disconnect there, which also makes it harder to enforce changes at home.”

Mary Moran
Clinical nurse specialist Mary Moran also works with families in the study. She worries about pizzas and French fries served at school lunches and the fact that most children get physical education only two or three times a week.

Mary Moran, a clinical nurse specialist who also is working with Tyler, agrees that prevention and working with families are critical.

“Starting with kids who are already overweight is much harder,” she said. “Most people know that never starting bad habits is easier than trying to correct them.”

There are many factors working against the families, said Moran.

“We hear stories about what is offered for school lunch, for example,” she said. “Most of our families qualify for free school lunches and breakfasts. They can’t afford to take their own healthy sack lunch to school.

“So the kids get breakfast pizzas everyday and French fries as the main vegetable. Plus, they get physical education only two or three times a week.”

But the blame does not fall totally with the schools.

“Ultimately, parents have a huge role in this because these kids are too young to go out and buy their own food,” White said.  “If mom and dad are buying lots of junk food and don’t buy fruits and vegetables, the kids have no chance.”

Like Tyler, the nurses are careful not to use labels with the children.

“Our aim is teaching a lifetime of healthy choices, not getting them to lose weight,” said Moran. “Putting a label on their weight status puts more emphasis on their current measurements or how they look. The goal is to make positive changes for life, not to lose 10 pounds in the next few weeks.”

It is also important for parents to be good role models for children, said Tyler.

“If they see you eating healthy and enjoying physical activity,” she said, “they will want to do the same, hopefully for the rest of their lives.”

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  Updated 11 December 2006
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