The Rising Childhood Obesity Epidemic

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By Helen Papaconstantinos BA, CNP, RNCP

Could Canada’s younger generations be expected to live shorter lives than their parents because of obesity? It is a chilling thought, but over the last 25 years, Statistics Canada reports have shown a considerable increase in the percentage of children and adolescents who are overweight and obese.

By 1981 these rates had tripled, however, within the last 15 years, they grew by more than 50 percent in children ages six to eleven, and by 40 percent in children between the ages twelve and seventeen.[i] If this already sounds horrendous, the rates of obesity rates among First Nations children are 2-3 times higher than the Canadian average.[ii] Other worrisome facts are emerging:

  • There is an alarming increase in the number of children and adolescents developing Type-2 diabetes (sometimes termed ‘adult-onset diabetes) due to being overweight.
  • Breathing problems and sleep apnea (interruption of breath while sleeping), are a concern. With poor sleep, children may experience difficulty with memory and learning.
  • High levels of cholesterol and high blood pressure (risk factors for development of cardiovascular disease), are being found in obese children.
  • The American Heart Association published a statement in the March 21, 2007 issue of the journal Circulation, saying that the use of cholesterol-lowering drugs should be part of updated guidelines for treating children and adolescents with high-risk lipid abnormalities, especially cholesterol.[iii]
  • Joint deterioration problems due to extra pressure and weight on developing bones.
  • These children are experiencing mental health problems such as low self-esteem and depression.

These diseases are not occurring in ‘traditional societies,’ considered poor by North American standards.[iv] What is going on?

The Root Cause of Obesity and Disease: Undernutrition

Although a number of socio-economic factors are associated with whether you will become obese – such as income level[v], level of education, [vi] genetics (whether the parents are themselves obese)[vii] and, smoking during pregnancy[viii] – the combination of these factors, together with the nature of human metabolism, is putting young individuals into a trap from which it is very difficult to escape.

At the root of the obesity problem is something called ‘undernutrition’[ix] – a type of silent starvation that occurs when one consistently avoids or does not have access to nutrient-dense food. Obesity does not discriminate between rich or poor nations, but being poor means that your parents are more likely to purchase cheap, sugary, starchy, fatty carbohydrates and in order to quell your hunger.

Your body’s storage capacity for carbohydrates is quite limited, so when you consume more than you need, they are converted, via insulin, into fat and stored, thus increasing your risk for nearly every chronic degenerative disease. Insulin is useful – it is essentially a storage hormone that helps you store the excess calories from carbohydrates in the form of fat in case of famine. Chronically high blood levels of insulin, however, prevent fat from exiting storage sites to burn as fuel in cellular metabolism. In effect, the obese person is starving on a cellular level and naturally wants to eat more.[x]

Further to this, obesity changes the type of refined carbohydrate you will prefer. One study published in the February 2005 Journal of Epidemiology, showed that people with a higher body mass tended to eat carbohydrates with a higher glycemic index – foods such as white bread and refined sugars and other foods which cause a quick surge in blood sugar. Interestingly, the amount of carbohydrate consumed in the study made little difference. It was all about the type of carbohydrate consumed. ‘Good’ carbohydrates such as whole grains, fruits and vegetables do not have high glycemic indexes, and, not surprisingly, did not lead to weight gain.

Feast or Famine:

Obesity in parents is one of the strongest predictors of obesity in children, but it is difficult to tell how much is related only to genetics because parents also contribute lifestyle habits to their children.[xi] A recent Canadian survey based on longitudinal data, found that more than 70% obese adolescents retain their overweight and obese condition through adulthood. Very few individuals return to normal weight range.

Being thin during childhood does not necessarily protect a child form developing into an overweight adult either. In fact, the thinnest children tend to have the highest risk for adult obesity.[xii] The biology of starvation is this: in poverty stricken families, there is often a hunger-binging cycle that follows economic conditions in the household. When money comes in, people purchase cheap, abundant processed foods which fill them up. This leads to rapid fat storages – common after a period of going without food. This is simply how human metabolism works. When calories are scarce, metabolism slows down and muscle is lost. As a result, blood sugar imbalances initiate the process of insulin resistance, and conditions of pre-diabetes worsen. The cycle continues when the next paycheck comes in. For this reason, whether a child is thin or obese, it is crucial to emphasize the importance of nutritional, behavioural and physical fitness interventions as quickly as possible for all groups.

 

Is more exercise the answer?

Mandatory physical education classes until high school might not be the ticket to reversing the childhood obesity trend. A study published in the March 31 2009 edition of the Canadian Medical Association Journal found that while phys-ed does offer numerous health benefits, improving body mass index (BMI) in children was not one of them. “Although the physical activity interventions in the study were not successful in improving BMI, the reasons for failure were unclear,” wrote Dr. Kevin Harris of B.C. Children’s Hospital, one of the study’s authors.[xiii] While there were other health benefits –lowered blood pressure, increased lean muscle mass, bone mineral density and aerobic capacity, and improved flexibility – weight loss did not occur. Other studies have shown that increased exercise led to increased appetite. It must be stressed here that exercise is not useless, but it is not enough in addressing the obesity epidemic.

Multi-level Approaches to Obesity Needed:

In related commentary, in the same journal, Dr. Louise Baur argues from the University of Sydney, Australia points out that the obesity rates in France plateaued following a range of multi-level interventions such as:

  • Improved urban planning (i.e., adding more playground areas and play equipment)
  • Provision of healthy meals in schools
  • Subsidies on fruits and vegetables for schools and daycares.
  • Beginning in 1992 children in the towns of Fleurbaix and Laventie received significantly more nutritional education, with a focus on local, traditional French fare.
  • They were also encouraged to get involved in sports.

The outcome? The researchers found that as children’s knowledge of nutrition increased, the eating habits of the entire family changed, putting the rising rates of obesity on a plateau.[xiv]

The New Food Insecurity – Processed foods cost less than Whole Foods:

To arrive at a total systems approach to eradicating obesity, something must be done around educating people about the type of crops that contribute to the very condition they need fixed. In the United States, government subsidies continue to support an agriculture industry that focuses on producing cheap sugar and fats from corn and soy. Both crops fuel obesity. Functional Medicine physician Dr. Mark Hyman asks us to consider: “You can fill up on 1200 calories of cookies or potato chips for $1, but you’ll only get 250 calories from carrots for that same $1, so if you were hungry, what would you buy?”[xv]

Sadly, processed foods have become cheaper as real food has become more expensive. The US Department of Agriculture (USDA) reported that between 1985 and 2000 the retail price of carbonated soft drinks rose by 20 percent, fats and oils by 35 percent, and sugars and sweets by 46 percent. On the other hand, there was an118 percent increase in the retail price of fresh fruits and vegetables. In 15 years the price of vegetables ballooned six times as fast as the cost of sugary, calorie-rich, nutrient-poor sodas.[xvi]

If you are poor and have no car or bus fare, comparison shopping is a problem, and in many communities, the only place to buy food is a local convenience store where fruits, vegetables and ‘real foods’ never make it to the shelves. Says Lise Duboise, Epidemiology professor at the University of Ottawa, “…there is segregation in terms of access to healthy food.”

Another conundrum – cheap food is biologically addictive:

Foods made ‘in a plant’ (rather than grown on a plant), as Michael Pollan would say, are biologically addictive.[xvii] Sugar stimulates the brain’s reward centers through the neurotransmitter dopamine exactly like other addictive drugs.[xviii] Brain imagining (PET scans) show that high-sugar and high-fat foods work just like heroin, opium, or morphine in the brain.[xix] Both obese people and drug addicts have fewer dopamine receptors, making them more likely to crave things that boost dopamine and that feeling of reward. Foods high in fats will also raise opiate-like substances. And just like drugs, after an initial period of “enjoyment” the user starts regularly consuming them to feel normal.

Binge-eating then leads to profound physiological change, which steps up calorie consumption and weight gain. In a Harvard Study published in the Journal of the American Medical Association, overweight adolescents consumed an extra 500 calories a day when allowed to eat junk food as compared to days when they weren’t allowed to eat junk food. [xx] They ate more because the food triggered cravings and addiction. Once they started eating processed food full of the sugar, fat, and salt that triggered their brain’s reward centers, they couldn’t stop.

Unfortunately, food manufacturers refuse to release any internal data on how they put ingredients together to maximize consumption of their food products despite requests from researchers. In his book, The End of Overeating, David Kessler, MD, the former head of the Food and Drug Administration, describes the science of how food is made into drugs by the creation of hyperpalatable foods that leads to neuro-chemical addiction. It is downright crazy that someone has thought of such things.

Ok, so what CAN be done? Healthy Eating Habits at Home:

The number one piece of advice is don’t get hungry, says weight loss and bariatric surgery specialist Dr. Yoni Freedhoff. Research studies show that low blood sugar levels are associated with lower overall blood flow to the brain. This means BAD decisions when you are hungry.

  • Make sure everyone in your household has had a healthy breakfast before going to school or work. Studies repeatedly show that eating a healthy breakfast helps people maintain weight loss. Studies repeatedly show that eating a healthy breakfast helps people maintain weight loss.
  • To keep blood sugar stable, eat a nutritious breakfast with some protein like eggs, protein shake or nut butters. Studies show that low-glycemic meals keep children full and satisified.[xxi]
  • Even 100% Fruit juice is like candy. Send your children to school with a bottle of pure water each day. It is far better to provide your family with the whole fruit so that they feel full, get all the fibre, and get the phytonutrients that juicing and heat-pasteurizing takes out. Just one of those ‘no added sugar’ juice boxes contains the equivalent of at least 5 teaspoons of sugar. Drinking more than 12 ounces a day of 100% fruit juice has been linked to an increased risk of obesity [xxii]
  • Eliminate sodas, all sugars and artificial sweeteners from your diet, as these can trigger cravings.
  • Avoid flavoured yoghurt. These products are loaded with sucrose and high-fructose corn syrup Homemade yoghurt costs 1/3 the price of commercial yoghurt. Make it yourself with this recipe http://www.cookforgood.com/. This website will also teach you how to save money if you are on food assistance, by cooking from scratch.
  • Pack vegetables in that lunch bag and go easy on starches. According to data from the 2004 CCHS, 59% of Canadian children and adolescents were reported to consume fruits and vegetables less than five times a day. This group of individuals were significantly more likely to be overweight or obese than were those who ate fruit and vegetables more frequently (Statscan, p. 3)
  • Don’t fall into the ‘I’m running late, I’ll pack this’ trap.

Lifestyle changes:

  • · Get at least 8 hours of sleep. Research shows that lack of sleep increases cravings.
  • Get moving and play less video games. A 2000 study published in the Canadian Medical Association, reported that the average Canadian child spends 3-5 hours a day inactive or sitting in front of a computer screen. This increase was especially notable among teenagers aged 13-to-17, whose overweight/obesity rates more than doubled, and in many cases, tripled.
  • Educate your children to step around junk food landmines in school cafeterias, vending machines, and other such areas.
  • Determine if hidden food allergies are triggering cravings. We often crave the very foods that we have a hidden allergy to. If it is a non-food allergy, remove it from your environment.
  • Read food ingredient labels together with your children. Prepare them for real life – talk to them about good nutrition, the growing problem of obesity.

Optimize Your Nutrient Status:

  • Optimize your vitamin D levels: When Vitamin D levels are low, the hormone that helps turn off your appetite doesn’t work and people feel hungry all the time, no matter how much they eat.
  • Optimize omega 3s: Low levels of omega-3 fatty acids have also been associated with depression, Alzheimer’s disease and obesity. EPA especially helps with depression.
  • Consider natural supplements for cravings control if the problem is severe. Glutamine, tyrosine, 5-HTP are amino acids that help reduce cravings. Stress reducing herbs such as Rhodiola can also help. Chromium balances blood sugar and can help take the edge off cravings. Glucomannan fiber is very helpful to reduce the spikes in sugar and insulin that drive cravings and hunger. Otherwise, cutting out sugar cold-turkey and having a little protein at each meal can help to cut cravings. You will notice a difference in 3-4 days. Always work with a Certified Holistic Nutritionist in making these changes.

Things you can do at the Community and Political Level:

  • In Ontario, all junk food in schools must be removed by September 2011. Is this in progress? If not, speak to your child’s school principal or report the problem to your local school board.
    • PepsiCo has announced plans to voluntarily stop selling sugary drinks in primary and secondary schools around the world by 2012. The move, prompted in part by an initiative developed by The World Heart Federation, is aimed at fighting rising childhood obesity rates around the world. Unfortunately, while sugary drinks will be off the menu, Pepsi will still be selling diet sodas in secondary schools. If this concerns you, contact your school principle or school board members.[xxiii] Coca Cola also has announced it will stop selling its products in primary schools, unless parents or school authorities request them, but it also wants to offer a full-range of low-calorie beverages alongside regular soft drinks in secondary schools.
    • Work to end food marketing to children. 50 other countries worldwide have done this, why haven’t we? According to the Canadian Paediatric Society, most food advertising on children’s TV shows is centered on fast foods, soft drinks, candy and pre-sweetened cereals. Commercials for healthy food make up only 4 per cent of what is shown. Fast food chains spend more than 3 billion dollars a year on advertising, much of it aimed at children. To directly target children, the fast food industry uses incentives such as playgrounds, contests, clubs, games, and free toys and other merchandise related to movies, TV shows and even sports leagues. Check out: Media Awareness Network, ‘Special Issues for Children’ http://www.media-awareness.ca/english/parents/marketing/issues_kids_marketing.cfm .

Above all, have the right structures in place. Parents are THE most important influences in children’s lives. They can set the pace for learning healthy food choices but they must be positive role models. Children, (just like adults) learn by example, so, eat together as a family, around a table and not in front of a television. Have your kids eat the same meals that you do and by eat 3 balanced meals daily yourself. Focus on your child, not the weight. Never, ever put children on a strict diet. They need their nutrients. Also, don’t single out kids when you serve an occasional treat. If you are giving out a treat to your other children, don’t deny one child because he is overweight. Just try to make it a healthy treat! Here’s something you can try today:

Blueberry Sorbet made without eggs

Blueberries are wonderful (and low glycemic). You can also try using cherries or any type of berry. Nut and hemp milks are not as high-glycemic as rice milk or soy milk. The blueberries contain mucilage, fibre, and proanthocyanidin antioxidants (13,427 Antioxidant Activity per serving); the almond milk contains plant proteins.

 

Ingredients:

1 cup frozen organic blueberries

2 Tbs unpasteurized honey

3 cups of organic almond or hemp milk (unsweetened)

1/2 tsp goats milk whey powder to prevent ice crystals.*

*Do not use xantham gum – it is mixed with corn starch and derived from a type of mold. Also do not use guar gum as it can gum up the intestinal lining.

Method:

1. Pulse mixture in blender until smooth.

2. Turn on ice cream machine and pour into machine.

The ice cream will be ready in about 20 minutes. The mixture can be poured into paper cups and left to semi-harden in the freezer until a teaspoon ‘handle’ can be inserted. Voila, blueberry frozen treats without any additives! Serves 4


[i] As far back as 2004, we were made aware through Statistics Canada that 18 percent of Canadian children and adolescents were overweight and 8 percent were obese. Later, in March 2007, the House of Commons Standing Committee on health released a report on childhood obesity which noted that childhood and adolescent obesity rates had indeed spiked over the past three decades. Also see:

Lobstein T, Baur L, Uauy R. (2004). Obesity in children and young people: A crisis in public health. Obesity Reviews; 5(Suppl. 1): 4-85.

[ii] Public Health Agency of Canada (March 2007). Childhood Obesity and the Role of the Government of Canada, Retrieved 22 March, 2010 from: http://www.phac-aspc.gc.ca/ch-se/obesity-eng.php

[iii] American Heart Association Scientific Statement: Statement addresses use of cholesterol drugs in children, 21 March 2007 Available at: http://www.newsroom.heart.org/index.php?s=43&item=294

[iv] Dr. Weston Price and his followers believe that processed vegetable oils, trans-fats, and refined carbohydrates are the real culprits in the modern world’s poor health.The Weston A Price Foundation argues that “human beings have been consuming saturated fats from animal products, milk products and the tropical oils for thousands of years without problems or degenerative diseases.” It is only in the last 100 years or so that diet-based diseases such as heart disease, diabetes, and cancer have reached epidemic proportions. For further reading see: www.westonaprice.org

[v] Obesity is highest amongst poorer families, who may have difficulty providing healthy food choices and physical activity opportunities for their children. As income level drops, the prevalence of obesity in children aged 13 to 18 years old rises. See: Feldmen and Beagean, 1994; US Centre on an Aging Society, 2002.

[vi] In terms of education, young people in households where no members had more than a high school diploma were more likely to be overweight/obese than were those in households where the highest level of education was postsecondary graduation.

[vii] American Academy of Child and Adolescent Psychiatry (May 2008). Obesity in Children and Teens. No.79. Retrieved 21February, from: http://www.aacap.org/cs/root/facts_for_families/obesity_in_children_and_teens

[viii] When a mother smokes during her pregnancy, her child has a 21.6 per cent change of being overweight by age seven, compared with 13.4 per cent for children born to non-smoking mothers. Exposure to cigarette smoke affects a fetus’s metabolism according to some research.

[ix] Undernutrition is usually thought of as a deficiency primarily of calories (that is, overall food consumption) or of protein. Undernutrition, a term often used interchangeably with malnutrition, is actually a type of malnutrition. Malnutrition is an imbalance between the nutrients the body needs and the nutrients it gets. Thus, malnutrition also includes overnutrition (consumption of too many calories or too much of any specific nutrient—protein, fat, vitamin, mineral, or other dietary supplement). Merck Online Medical Library: Undernutrition http://www.merckmanuals.com/home/sec12/ch153/ch153a.html Last full review/revision August 2007 by David R. Thomas, MD

[x] Czapp, Katherine, Book Review: Good Calories, Bad Calories by Gary Taubes, Knopf, 2007, 22 March, 2009, Weston A. Price Foundation, http://www.westonaprice.org/book-reviews/thumbs-up/1370-good-calories-bad-calories-by-gary-taubes.html

[xi] In Britain, a 50 year study of 412 people, published in the British Medical Journal, found that obese teens tended to become obese adults. The most overweight 13 year-olds were twice as likely as the rest of the children in the study, to become adults with the highest percentage of body fat.

[xii] Wright, CM, Parker L, Lamont D, Craft AW (Dec. 1, 2001). Implications of childhood obesity for adult health: findings from thousand families cohort study. British Medical Journal 2001. 323(7324):1280-4)

[xiii] CBC News, ‘Fighting Childhood Obesity: Is phys-ed enough? Tuesday June 2, 1009, http://www.cbc/health/story/2009/03/31/f-phys-ed-obesity.html

[xiv] Ibid.

[xv] Hyman, Mark, ‘Not having enough food causes obesity and diabetes, http://drhyman.com/not-having-enough-food-causes-obesity-and-diabetes-2280/ , p. 3. Retrieved March 20, 2011.

[xvi] http://articles.mercola.com/sites/articles/archive/2011/02/19/the-dirty-little-secret-hidden-in-much-of-your-health-food.aspx

[xvii] Food is addictivehttp://drhyman.com/food-addiction-could-it-explain-why-70-percent-of-america-is-fat-2499/

[xviii] Colantuoni C, Schwenker J, McCarthy J, Rada P, Ladenheim B, Cadet JL, Schwart GJ, Moran TH, Hoebel BG Excessive sugar intake alters binding to dopamine and mu-opioid receptors in the brain. http://www.ncbi.nlm.nih.gov/pubmed/11733709

[xix]Volkow ND, Wang GJ, Fowler JS, Logan J, Jayne M, Franceschi D, Wong C, Gatley SJ, Gifford AN, Ding YS, Pappas N. “Nonhedonic” food motivation in humans involves dopamine in the dorsal striatum and methylphenidate amplifies this effect. 2002 Jun 1;44(3):175-80.http://www.ncbi.nlm.nih.gov/pubmed/11954049 Synapse.

[xx] http://jama.ama-assn.org/content/291/23/2828.abstract

[xxi] Evidence Summary: Low Glycemic Load Diets and Satiety in Children: 3 randomized, controlled trials. See: http://www.adaevidencelibrary.com/evidence.cfm?evidence_summary_id=250381&auth=1

[xxii] Am Academy of Paediatrics, 2001; Mrdjenovic & Levitsky, 2003.JUICE

[xxiii] Pepsi to stop selling sugary drinks in schools worldwide’, 18 March, 2010, http://www.lesliebeck.com/page.php?id=3005&type=art