Kids and Health Care: Obesity

CF is a chronic disease that hurts and kills children. Obesity is a chronic condition that does the same -- though not as quickly.

Through the 2000s, the U.S. health care industry has turned a collective blind eye to the fattening of Americans and, especially, American kids. But the health effects of heaviness are starting to take a measurable toll on U.S. medical expenditures; so, insurance companies, managed care plans and other financing entities have started paying more attention to obesity.

Some of this attention has taken the form of dietary and nutritional education programs for plan members (and this is especially true for families participating in state CHIPs). But, despite their best efforts, insurance companies aren't as good at consumer education as they are at discouraging risky behavior by raising premiums. That's a trend that many risk experts predict for the 21st Century: Closer insurance underwriting attention to weight -- and higher insurance costs for fat people.

The actuarial evidence backs up the predictions.

The best measure of obesity is the body mass index (BMI), which is the ratio of weight in kilograms to the square of height in meters. Standard pediatric growth charts for the U.S. population include BMI for age and gender; these are readily available online, including at the Centers for Disease Control and Prevention's Web site (www.cdc.gov/growthcharts).

BMI between 85th and 95th percentile for age and sex is considered at risk for overweight; BMI at or above the 95th percentile is considered overweight or obese.

The incidence rate of obesity among children and adolescents doubled between the 1980s and 2000s.

In the early 2000s, 15.3 percent of 6- to 11-yearolds and 15.5 percent of 12- to 19-year-olds were at or above the 95th percentile for BMI, with even higher rates among subpopulations of minority and economically disadvantaged children.

The U.S. Surgeon General's Office has predicted that morbidity and mortality associated with obesity may exceed those associated with smoking.

Fat children are more likely to have high blood pressure and high cholesterol. They're more likely to develop diabetes, have pulmonary problems (asthma, sleep apnea, etc.), orthopedic problems and gastrointestinal trouble. And, adding insult to in-jury -- literally, they're more likely to have psychological problems.

Obesity lingers. The probability of childhood obesity persisting into adulthood ranges from about 20 percent at age 4 to 80 percent by adolescence.

It's long been recognized that obesity "runs in families" -- high birth weight, maternal diabetes and obesity in family members all are factors -- but it's also true that interaction between genetics and environment affects weight. Some examples:

• The extent and duration of breastfeeding have been found to be inversely associated with risk of obesity in later childhood. Why does mother's milk keep kids from getting too heavy? The chemistry of the milk may encourage healthy development; more likely, breastfeeding correlates with other parenting patterns that head to a healthier lifestyle.
• Adolescence is another critical period for development of obesity. The normal tendency for hormonal changes during early puberty creates spikes in body chemistry that are natural cofactors for excessive weight gain. Girls who start menstruation early are up to twice as likely to be obese at some point in their lives than girls who start later.
• The brace of psychological issues that health care experts cautiously call "food insecurity" also lead to obesity. These issues can include excessive parent/child conflict, overcontrolling parents, family instability, the child's socio-economic status and unhealthy eating habits learned from parents -- even if they don't fight too much.

But even if they don't have food insecurity, kids in the U.S. are less active in the early 21st Century than earlier times. Leisure activity is increasingly sedentary, with wide availability of entertainment such as television, videos and computer games. In addition, with increasing urbanization, there has been a decrease in frequency and duration of physical activities of daily living for children, such as walking to school and doing household chores. Changes in availability and requirements of school physical education programs have also generally decreased children's routine physical activity.

All of these factors play a potential part in the epidemic of obesity -- but the sedentary lifestyle is perhaps most important. Kids who watched four or more hours of TV per day had significantly greater BMI, compared with those watching fewer than two hours per day. Having a TV in the bedroom has been reported to be a strong predictor of obesity, even in preschool-aged children.

The best way you can avoid obesity in your kids is to breastfeed them, maintain a stable home, teach them good eating habits (without being overcontrolling) and -- most important -- keep them active. Don't let them plug into MTV or their Gameboys.

These efforts will pay dividends over time. Health insurance underwriting will focus on weight issues increasingly in the 21st Century; companies may ask for BMI numbers as commonly as they ask for blood samples. And overweight people -- including kids -- will pay more for coverage.