Physicians Page

Fructose Intake is Key to Obesity Genesis
New research is turning our understanding of obesity upside down! We are now uncovering the biochemistry of how the body manages our energy intake and use. This new knowledge gives us a solid basis of how to prevent and treat both childhood and adult obesity. The whole system is outlined in a recent paper by Dr Robert Lustig.   [see a synopsis]

Activity Level as Important as Diet in Maintaining Healthy Weight
Current trends point to exercise as a key factor in maintaining a healthy weight. Schools are starting to put Physical Education back into the curriculum after its near demise in the 1990's. Many weight programs are using pedometers to encourage children to walk more. Besides walking, there are a great variety of recreational activities that promote fitness and healthy weight. How do we get our patients to get involved in these activities? A traditional way for doctors to get patients to do something is to write a prescription, and recent studies have found that prescriptions for behavior change actually do work to some extent.

Below we have outlined a way to prescribe exercise for your patients, and have provided you with an easy-to-use format that can be made into prescription pads for use in your office. If you live near Bowling Green, you can get these pads already made up for free at the Health Dept.

Why should we make the effort to measure BMI on our patients?

The Bogalusa Heart Study has published results (Pediatrics, Jan 2005) indicating that "BMI's of even 2- to 5-year-olds were moderately associated with adult adiposity." The older the child, the stronger the chance of remaining obese. In other words, even toddlers with high BMI's are at risk, but the sooner we can find them, the better our chances of reversing the problem.

Physicians in the past have not been good about identifying children at risk of overweight, and doctors have not been informing parents that their child is overweight. Healthy Weight Kids Coalition has conducted a survey in pediatricians' offices, where parents were asked if they felt their own child was overweight. Based on actual BMI calculations, only 10% of parents correctly identified their own child as overweight. Even if we don't have the time or resources to treat our overweight patients, doctors would be doing a great service to their patients by merely identifying them as at risk of overweight. Parents can start seeking help from new resources such as this website, and begin to take action.

Using a BMI calculator wheel is very quick and easy. As your nurse or office assistant weighs and measures a child, he or she will plot a point on the growth chart and write the actual weight and height in the chart. Babies under 2 will also get a head circumference charted, but over 2 years, they could instead get a BMI listed in the chart. Any BMI over the 85th percentile for age could be circled to alert the physician.

Some of our pediatricians are changing over to EMR (electronic medical records) and have chosen software that automatically calculates the BMI for each patient. Make sure your software does this if you are getting an EMR system!

Overweight is Epidemic

All children can maintain a healthy BMI by eating a nutritious diet and getting enough daily exercise. There are several hereditary factors that may make it more difficult for some children to maintain a healthy weight, but these factors can be overcome by adherence to proper nutrition, and getting appropriate amounts of exercise. Bottom line: when energy expenditure and energy intake are controlled, it is physically impossible to gain weight, irregardless of any other medical or non-medical factors.

In the last 30 years, the percentage of overweight children has increased from 15% to nearly 30%. This change is due largely to a gradual shift in the eating habits and activity patterns in both children and adults. Children identified as overweight need to be treated early to avoid severe health problems for the rest of their lives. These include heart disease, stroke, hypertension, diabetes, stress injuries and accidental trauma.

As shown at the right, obesity is rapidly overtaking tobacco as the leading preventable cause of death in the USA.

Check Lipids in Your Overweight Kids

We have been used to checking lipids in overweight children with elevated blood pressure, but recent evidence shows that ALL overweight kids are at risk for hyperlipidemia (Pediatrics, Aug 2005).

How Can Physicians Get Schools to Help?

Most schools are ill-equipped to deal with the obesity epidemic, yet have the potential to greatly influence a positive change! Physicians are in a good position to aid schools through community coalitions, school boards, and forming smaller alliances with teachers and principals.