July 22, 2013 by

Loving, affectionate, intelligent, and a bookworm—that’s how parents described their young teenage daughter. Weighing more than 200 pounds, she often hid behind her books because it helped her feel invisible, a feeling she preferred to the teasing she endured for her acne and weight.

When she first came to the Healthy Eating with Resources, Options, and Everyday Strategies (HEROES) program at Children’s Hospital & Medical Center, staff saw a shy, withdrawn, and sad young lady who stayed mostly in the background. Slowly but surely, however, she began to emerge as a leader in the group. She lost more than 30 pounds and started to incorporate fitness into her daily life. She soon discovered a love for running. After completing six months with the program, this young lady had become an intricate part of the group. She talked about the newness of having boys notice her—something that had never happened before—and she gradually began to regain her self-esteem.

The staff at HEROES says scenarios like this are quite common among obese children, and, many times, parents don’t know how to help or change the situation.

These children are often caught in a vicious cycle, notes Cristina Fernandez, M.D., pediatrician and medical director of the HEROES program. “They are bullied and made fun of, which lowers their self-esteem and makes them depressed,” she says. “This then feeds into their eating and weight problem. One of our teenage girls told us her classmates were throwing food at her like they were feeding an elephant.

Cristina Fernandez, M.D., pediatrician and medical director of HEROES

Cristina Fernandez, M.D., pediatrician and medical director of HEROES. Photo by Bill Sitzmann.

“We can turn their lives around. These children need to know they can change, they can do better, and they can do it every day. We teach them how. The quality of life for these children improves significantly once they have been in our program for a while.”

Obesity is a growing problem in this country. The American Academy of Pediatrics reports that 20 percent of children in this country are overweight or obese. The problem may be even worse in the Omaha metropolitan area. A 2012 survey conducted by Children’s Hospital and Boys Town National Research Hospital found that 30 percent of children aged 5 to 17 years old were overweight or obese.

Obesity is a multi-factorial disease, says Fernandez. While genetics may play a role, the majority of children are overweight due to their environment and an unhealthy lifestyle. Lack of exercise, extra-large portion sizes, excessive snacking, and overconsumption of fast foods, as well as excessive time spent in front of computers and video games, are all taking a toll.

Minorities like Latinos and African-Americans have a higher rate of obesity than the Caucasian population, and this appears to be in large part due to their environment, notes Fernandez.

But obesity is about more than being overweight. It is a chronic disease and serious health problem that can lead to numerous health conditions, including type 2 diabetes, coronary artery disease, high blood pressure, high cholesterol, sleep apnea, chronic headaches, venous stasis disease, urinary incontinence, liver disease, and cancer.

If the situation is not turned around, these children will begin having the types of health problems in their 20s and 30s that we normally see in people in their 60s and 70s, explains Fernandez.

Losing weight and maintaining an ideal body weight often requires a multi-faceted approach that includes medical management, nutrition counseling and education, exercise, behavior modification, and behavior therapy.

“Our goal is to help them work through their barriers,” says Martha Nepper, MS, RD, LMNT, certified diabetes educator and certified childhood and adolescent weight manager with Nebraska Methodist Health System. “It’s about getting accurate information about diet and nutrition and the proper support. For some children, that might be individual counseling, while others might benefit more from group classes and support.”

Martha Nepper, MS, RD, LMNT, Nebraska Methodist Health System

Martha Nepper, MS, RD, LMNT, Nebraska Methodist Health System. Photo by Bill Sitzmann.

Nepper works with LifeShapes, a program sponsored by Nebraska Methodist Health System that provides nutrition counseling and support for overweight and obese kids and teens.

Nepper says it’s a process that requires both the child and the parents to achieve the greatest success. “Parent involvement is extremely critical,” she says. “The parents are the gatekeepers—they control what comes into the house. The adoption of healthy habits, including diet and exercise, needs to start with them.”

Nepper adds that, oftentimes, just making small dietary changes can help decrease caloric intake enough to halt weight gain and allow children to grow into their weight. This includes steps like trading sugary beverages (like pop and Gatorade) with water, decreasing portion sizes, increasing consumption of fruits and vegetables, and having more family meals.

Some common things for parents to avoid include:

  • Pressuring children to clean their plates
  • Allowing children to have televisions in their bedrooms
  • Bringing too many energy-dense foods into the house, like cookies, chips, and toaster pastries
  • Not being a good role model by not exercising regularly or participating in activities that involve exercise with their children
  • Eating out too often and too much fast food

Using the U.S. Department of Agriculture’s (USDA) MyPlate is a great way to determine what should be on your child’s plate, says Nepper. With MyPlate, half of the plate should be fruits and vegetables with the remaining half split between proteins, whole grains, and dairy.

Even after completing an intervention program, these children do best when they come back for occasional follow-up visits. “It’s a lifelong battle,” says Fernandez. “A smoker or an alcoholic can stop using tobacco or alcohol; we can’t stop eating.”

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