Happy Jack Hovis was just a month old when he came to live with his aunt Terry Hunter in Charlotte, N.C. She remembers feeding the new baby one evening, then bathing him and settling him into his crib for the night. "He lay in bed and just smiled and smiled and smiled," she says fondly. "I told him, 'You are one Happy Jack!' " As he grew, the bright-eyed boy rarely fussed about his food. He loved fried chicken and green beans cooked in fatback, and he really loved eating at McDonald's. By the age of 4, he was so rotund that his pediatrician referred him to a heart specialist and, later, to a hospital-based weight clinic. Happy Jack is now 6, and following a program that combines regular exercise with smaller servings of lighter foods. The regimen is working--he has maintained roughly the same weight for 10 months, two inches taller. But at 118 pounds, he still weighs nearly twice what is normal for his age and height. For this child, slimming down isn't an aesthetic issue. His health--even his life--may depend on it.
Children's impulses haven't changed much in recent decades. But social forces--from the demise of home cooking to the rise of fast food and video technology--have converged to make them heavier. Snack and soda companies are spending hundreds of millions a year to promote empty calories, while schools cut back on physical education and outdoor play is supplanted by Nintendo and the Internet. The consequences are getting serious. By the government's estimate, some 6 million American children are now fat enough to endanger their health. An additional 5 million are on the threshold, and the problem is growing more extreme even as it becomes more widespread. "The children we see today are 30 percent heavier than the ones who were referred to us in 1990," says Dr. Naomi Neufeld, a pediatric endocrinologist in Los Angeles.
Obese kids suffer both physically and emotionally throughout childhood, and those who remain heavy as adolescents tend to stay that way into adulthood. The resulting illnesses--diabetes, heart disease, high blood pressure, several cancers--now claim an estimated half-million American lives each year, while costing us $100 billion in medical expenses and lost productivity. U.S. Agriculture Secretary Dan Glickman predicts that obesity will soon rival smoking as a cause of preventable death, and some health experts are calling for national action to combat it. Meanwhile, the challenge for children, and their parents, is to swim against the current.
Until recently, childhood obesity was so rare that no one tracked it closely. Body-mass index (BMI), the height-to-weight ratio used to measure adult heft, seemed irrelevant to people whose bodies are still growing. But that mind-set is changing. In a gesture aimed at parents and pediatricians, federal health officials recently published new growth charts that extend the BMI system to children. Unlike the adult charts, which classify anyone with a BMI of 25 or higher as "overweight" and anyone with a BMI of 30 or more as "obese," the childhood charts (following page) use population norms from the 1960s to determine healthy weight ranges for kids 2 to 20. According to the new charts, a typical 7-year-old girl stands 4 feet 1 inch tall and weighs 50 pounds, giving her a BMI of 15. By the age of 17, she stands 5 feet 4 and weighs 125 pounds, for a BMI of 21. To spare parents undue alarm over baby fat or the normal weight gain that precedes growth spurts, the new charts use a broad definition of healthy weight. To be "at risk" of becoming too heavy, a child must fall above what was the 85th percentile during the 1960s (145 pounds for that 5-foot-4-inch girl). Only after hitting what was the 95th percentile (170 pounds for the same girl) does one become "overweight."
Even by these lenient standards, the proportion of kids who are overweight jumped from 5 percent in 1964 to nearly 13 percent in 1994, the most recent year on record. If the trend has continued--and many experts believe it has accelerated--one child in three is now either overweight or at risk of becoming so. No race or class has been spared, and many youngsters are already suffering health consequences. Dr. Nancy Krebs, a pediatrician at the University of Colorado, notes that overweight children are now showing up with such problems as fatty liver, a precursor to cirrhosis, and obstructive sleep apnea, a condition in which the excess flesh around the throat blocks the airway, causing loud snoring, fitful sleep and a chronic lack of oxygen that can damage the heart and lungs.
Even type 2 diabetes--known traditionally as "adult-onset" diabetes--is turning up in overweight kids. "Ten years ago I would have told you that type 2 diabetes doesn't occur until after 40," says Dr. Robin Goland of New York's Columbia-Presbyterian Hospital. "Now 30 percent of our pediatric patients are type 2." Unlike type 1 disease, in which the pancreas fails to produce the insulin needed to transport sugar from the bloodstream into cells, type 2 diabetes occurs when a person's cells grow resistant to insulin, causing sugar to build up in the blood. Unless it's carefully managed, this obesity-related condition can damage blood vessels within a decade, setting the stage for kidney failure and blindness as well as amputations, heart attacks and strokes. And because children are not routinely screened for type 2 disease, Goland worries that many cases are going undiagnosed. "You can have this condition without knowing it," she says.
Even if they don't develop diabetes, chronically overweight kids may become prime candidates for heart attacks and strokes. In a recent survey of preschoolers at New York City Head Start Centers, Dr. Christine Williams of Columbia University found that overweight kids as young as 3 and 4 showed signs of elevated blood pressure and cholesterol. "There's a lag between the development of obesity and the chronic diseases associated with it," says Dr. William Dietz of the Centers for Disease Control and Prevention. "We're in that trough right now. Very soon we'll see the rate of cardiovascular disease among teenagers rising."
How does a child end up in this predicament? Genes are clearly part of the story. Nine-year-old Emily Hoffman of Humble, Texas, was born weighing nearly 11 pounds. And though she was raised in ways her pediatricians approved of, everything she ate seemed to turn into fat. By 7 she weighed 180 pounds. But even in kids who are prone to obesity, lifestyle is what triggers it. Felice Ramirez weighed 200 pounds when she started eighth grade in Victoria, Texas, three years ago. And though she has since lost 25, she is constantly nudged in the wrong direction. "My friends go to McDonald's and Sonic and Casa Ole and they just eat and eat," she says. "And when they're not eating, they go to the mall." She has a P.E. class at school, but sitting on the bleachers counts as participation. And though the school cafeteria tries to offer healthy fare, the lines are so long, and the lunch period so short, that kids are often forced to dine on packaged snacks from the vending machines.
These are common temptations. Many schools now feature not only soda and snack machines but on-site outlets for fast-food chains. At the same time, recess and physical education are vanishing from the schools' standard curriculum. Virginia is now the only state that still mandates recess as a daily routine--the Atlanta school system recently banned it in the hope of raising academic performance--and fewer than half of the nation's schools offer P.E. Not surprisingly, the proportion of high-school kids in daily gym classes fell from 42 percent to 29 percent during the '90s.
No one expects these trends to reverse any time soon. Cynics predict that we'll get serious about childhood obesity about 20 years from now, when today's youngsters are hobbled by arteriosclerosis and end-stage renal disease. But nutrition experts are so worried that some now advocate cigarette-style taxes on snack foods and soft drinks. Writing in the current American Journal of Public Health, activist Michael Jacobson and Yale psychologist Kelly Brownell note that a national one-cent tax on soda pop could generate $1.5 billion a year to promote healthful alternatives. (The soft-drink industry is understandably opposed.) Meanwhile, researchers are studying the effects of positive incentives to eat better. In one recent experiment, a team at the University of Minnesota found that when high-school cafeterias offered 50 percent discounts on carrot sticks and fresh fruit, sales increased two- to fourfold.
Protecting our kids may ultimately require such initiatives, but we don't have to wait for the world to change. Dr. Thomas Robinson, a Stanford pediatrician, has shown that simply limiting TV time can help immunize them against obesity. In a study involving 192 third and fourth graders, he found that those who held their screen time to one hour a day were measurably leaner after nine months than those who watched the tube at will.
Setting limits is important, but parents can often accomplish more by setting an example. When Kate Harned of Winter Springs, Fla., was an overweight 8-year-old, her mom's advice about diet and exercise served only to anger her. But when her mother joined Weight Watchers and dropped 55 pounds, her message started to resonate. Kate joined the program herself last year, at 14, and has since come down by six pants sizes. Celeste Santizo has a similar story. When she hit 116 pounds during the second grade this year, her family joined a Los Angeles-based program called KidShape. Besides cutting Celeste's TV time and persuading her to take up handball and tae kwon do, the KidShape counselors got her mother, Martha Santizo, to think differently about the family's routines--and her own. Martha started serving meals on salad-size plates to control portion sizes, and offering water instead of fruit juice when her kids got thirsty. She also bought a tape called "Sweatin' to the Oldies" and slimmed down herself. Eight weeks later, Celeste has lost four pounds and gained a new outlook on life. "She's friendlier," her mom observes. "She has more energy, and I think she's a much happier person." If warding off disease weren't reason enough to get active, that alone would make the case.