A super-sized problem in the Black Belt

Published 4:24 pm Wednesday, December 22, 2010

It’s not so unusual for someone in their 50s to deal with hypertension or high cholesterol.

But what if you haven’t even made it to your 10th birthday?

Childhood obesity is on the rise in the U.S., nearly tripling in the number of cases over the last 30 years.

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Alabama, which is second in the nation in the number of obese adults at 31.2 percent, ranks sixth nationwide with 36.1 percent of its children, ages 10-17, falling into the obese category.

Studies indicate states with high numbers of overweight or obese youth also have high rates of childhood poverty with low scores in measurements of childhood wellbeing.

In Alabama’s Black Belt, low education levels, high unemployment, limited access to healthcare and poor nutrition, combined with the trends of modern society, have  created an epidemic of childhood obesity in the region.

Dr. Eunice Bonsi, a professor in the Department of Food and Nutrition Sciences at Tuskegee University, says many low-income Black Belt families, particularly in the current tough economic times, turn to high-calorie, high-fat foods that are less expensive, resulting in excess weight.

“In many poor areas, fast food is more accessible than grocery stores, and the grocery stores that are located in more low-income areas often have a poor selection of fresh produce,” Bonsi said.

“When you combine culture, diet, lack of knowledge and limited resources, you end up with higher levels of obesity in the Black Belt. And heavy adults often raise heavy children,” Bonsi said.

Paying the price for the pounds

Children are paying “adult admission” for healthcare due to those excess pounds.

“We are now seeing children dealing with health issues no child should have to deal with,” said Ann Keen, a CRNP with Greenville Pediatrics.

“We have children with typically mid- and later-life adult health issues: high cholesterol, high triglycerides, hypertension.  We have also seen a dramatic increase in Type 2 diabetes and pre-diabetes—what we normally refer to as adult-onset diabetes—in children as young as six. It’s heartbreaking to put a young child on adult medications.”

If they aren’t put on a healthier path, the repercussions faced by these children are serious, Keen says.

“These kids will see the onset of complications from these health problems-diabetes, strokes and heart disease-at a much earlier age than we’ve seen in the past. It will be a great financial burden on society,” Keen said.

While there is some indication there is a genetic predisposition among African-Americans to carry extra pounds, there are even strong indicators this minority population has a genetic link to diabetes.

And excess weight can help usher in Type 2 diabetes and the myriad of problems associated with the disease, including kidney disease, blindness and lower-limb amputations.

Forget the old saw about “fat and jolly,” Keen says.

“Children who are morbidly obese tend to be much more likely to endure teasing and bullying. We see the emotional impact on them in our practice,” said Keen. “They tend to be a lot less socially active and adept and lack physical assertiveness. And when they are hurting emotionally, they will often turn to food, junk food, which just makes matters worse.”

Dr. Robert Keith, nutritionist for the Alabama Cooperative Extension Service, says if intervention is not provided to morbidly obese children at a young age, the odds of them growing up to be obese adults are greatly increased, becoming, like poverty itself, a vicious cycle.

“For years we’ve seen our life expectancy increase. However, with the growing number of morbidly obese children who are becoming morbidly obese adults, you will likely see many of them living an average of 7 to 14 years less than individuals with a healthy weight,” said Keith. “And we could very well see our life expectancy decline in Alabama and in the US as a whole if the current trend is not reversed.”

A different world

Times have changed, and those changes have helped contribute to an increasingly overweight and out-of-shape  population of children across our society.

“Kids in general are not getting the exercise they used to get. They are staying inside year round, playing video games, spending time on the computer and watching TV. And they’ve got access to a lot of unhealthy foods,” said Keen.

“We live in a fast food-oriented society now, and there are fewer meals eaten at home. We also see huge portions and super-sizing. No one, including adults, needs a super-sized meal.”

Parents lead by example. Unfortunately, it’s often the wrong example when it comes to a healthy diet.

“In many cases, overweight children have overweight parents,” said Keen.  “If parents have unhealthy eating habits and are inactive, the children fall into the same pattern. If you expect children to change their habits and get healthier, you’re pretty much fighting a losing battle if you, as a parent, aren’t making changes, too, by making better food choices and making the effort to get active with your children.”

Keen is not saying ban all fast food from your family’s diet.

“But you do need to eat it in moderation and watch portion size. And help your children make better choices.  Hold the mayo, hold the cheese. Go with the apple slices or banana with their chicken nuggets or burger,” she said.

Keen says many of the overweight children seen at their Greenville clinic are not involved in any type of sports during or after school.

“They aren’t even playing outside at home.  Children need to be encouraged to get outside, get involved in extra-curricular activities and get moving,” said Keen.

Back to school

Butler County Schools superintendent Darren Douthitt says public schools in Alabama are continuing  to make strides in improving food choices offered to students.

“We follow state regulations to the letter in regards to what we offer our students at break and at lunch. The meals have to be nutritionally balanced,” Douthitt said.

Federal guidelines put into effect starting in 2006 mandate only bottled water, milk and 100 percent fruit juices are offered in vending machines in elementary and middle schools, while high school vending machines can also offer no or low-cal beverages up to 25 calories, sports drinks and tea with a limit of 99 calories per serving.

Snacks offered in vending machines must also meet healthier nutritional criteria than in the past.

Under the National School Lunch Program, offerings in the cafeteria for full-price, reduced and free breakfasts and lunches must have no more than 30 percent of their calories from fat, with one-third of the RDA of protein, Vitamin A, Vitamin C, iron, calcium and calories.

And the days of the bake sale and doughnut fundraisers during school hours are a thing of the past, Douthitt says.

“Now, if a group is selling doughnuts, they can only be picked up after school. This has hurt sales for fundraising, but it just means we have to be more creative in raising funds,” Douthitt said.

“It certainly helps improve the nutrition the child is getting during the day. And the well-nourished child is the one who is going to better succeed in the classroom, that’s a proven fact.”

Teaching children about good nutritional choices needs to start at a young age, the experts say.  With an estimated 80 percent of children of preschool age in 40-hour daycare each week, establishing good eating habits in care could help get them off to a better start.

The Child and Adult Care Food Program can assist those who work in the arena of child daycare to provide the children they serve with nutritious meals and snacks, at no cost to the parents.

“Through CACFP, children in daycare can receive up to two meals and snacks that are healthy and balanced. The daycare providers actually receive training, support and monetary reimbursement for the foods they purchase to serve to the enrolled children,” said Lisa Nimmer, director of the non-profit Healthy Kids, which sponsors licensed family daycare in CACFP.

“It’s a win-win situation. The children receive healthy, nutritious food, the daycares receive reimbursements for meeting CACFP requirements, and this helps keep the costs of childcare down, which helps the parents.”

Nutrition Education classes are also offered to expectant and breastfeeding mothers and parents of infants and preschoolers through The Women, Infants and Children Program (WIC), which provides supplemental food for low-income mothers and children at nutritional risk.

Eat less, move more

With PE classes no longer mandatory for high school students, Alabama is the sixth lowest state in terms of students enrolled in such classes.

Youngsters are too sedentary these days, Douthitt says, and he is looking for ways to get them on the move.

“We want our PE teachers to be robust and to do their jobs and get our kids more active. That’s why I am implementing a Professional Development Plan for our PE teachers in the coming year,” Douthitt said.

“We want to come up with more structure and more creative ideas for our PE classes. My rule is no sitting in the gym during PE. Get up and get moving. PE is supposed to be physical, after all.”

While all students won’t make it onto a school sports team, Douthitt emphasizes the importance of community recreation leagues in getting children active.

“I am a coach on a rec league basketball team here, and I’m just not seeing as many children involved in this program as there should be,” he said.

“I also spend time playing basketball with my son at our house.  But something I have noticed is we don’t see a lot of kids and parents in the neighborhood doing likewise. Parents need to set the tone and be the role models.”

Changing attitudes, habits is key

It won’t be easy, Keith says, but with a concerted, committed effort, parents can go a long way to promote a healthier lifestyle for their children and themselves no matter what the income level.

“We aren’t going to get rid of computers or TVs or video games or fast food; they are part of the fabric of our society. But we can make changes in how we prepare our foods, in portion sizes, in how much TV or computer time we allow our kids,” Keith said.

“Parents need to be engaging in regular exercise with their children. It may be riding bikes or taking brisk walks or shooting hoops or something else.  The important thing is getting the kids active doing something they enjoy. It benefits the entire family. And it could help change our children’s future for the better.”