January 25, 2006

Childhood Obesity

I am concerned about my granddaughter. She is 9 years old, tall for her age, but markedly overweight. The family eats at fast-food outlets regularly, and she drinks large amounts of soft drinks daily. What do you advise?

You have reason for concern. The problem of childhood obesity is increasing at an alarming rate in developed and emerging countries. In the United States the number of overweight children has doubled between the years 1980 and 2002. (Overweight is defined as a body mass index at or above the 95th percentile for age and gender.)

Type 2 diabetes, which was found mainly in middle-aged people 30 years ago, is increasing rapidly in children. In the United States almost half of the newly diagnosed cases of type 2 diabetes are found in children. High blood pressure, increased insulin in the blood, and abnormal cholesterol and other blood fats are commonly present in overweight children. In the past 25 years problems associated with obesity such as gallbladder disease and breathing difficulty at night (sleep apnea) have increased threefold in children and adolescents.

Children who are overweight require a thorough evaluation. The family history should be studied, and all the dietary and activity patterns established. Features that may point to underlying congenital or hormonal abnormalities should be evaluated. This latter category accounts for a very small number of cases of childhood obesity.

1503 page28Particular attention needs to be given to the diet, and also the education of those responsible for providing the child?s nutrition. Foods high in calories and low in nutrition need to be eliminated and replaced with nutritious, less-calorific foods. Soft drinks are especially problematic, and should be eliminated. Activity needs to be encouraged.

Children spend a lot of time watching TV and playing video/computer games. Physical education at school should be encouraged, and specific advice given on regular and healthy exercise. Regular exercise is a vital intervention to preservation of health, and also to maintain weight loss.

Family engagement is critical. The problem needs to be addressed at the earliest age possible in order to prevent lifetime complications. Time is of the essence.

I caught my child eating paint flakes off the door. Is he at risk for lead poisoning?


Lead is a poisonous heavy metal. It was a common ingredient in household paint until several decades ago. Thus old paint may still contain lead. Adverse health effects of lead exposure in children may include intellectual and behavioral deficits. In adults high blood pressure and kidney damage may occur.

Blood lead levels (BLL) in the general population have declined sharply over the past 30 years. This probably reflects, among other things, the removal of lead from petroleum products. Blood lead levels in children aged 1-5 years dropped drastically over a 15-year period (1976-1991). However, some children in low-income families continue to have higher levels. Blood lead levels remained higher in American Black children than in non-Hispanic, White, or Mexican-American children, as was shown in follow-up studies carried on from 1999 through 2002. It is estimated that 300,000 or more children are at risk in the United States.

Obviously great success has been achieved by removing lead from gasoline, food cans, and household paint products. But the problem has not been totally solved. It is estimated there are still some 24 million housing units with lead paint hazards.

We think it unlikely that a single ingestion of a flake of old paint would hurt a child. Nevertheless, if there is any possibility this has been an ongoing practice, it would not hurt to get their BLL measured.

Allan R. Handysides, M.B., Ch.B., F.R.C.P. (c), is director of the General Conference Health Ministries Department; Peter N. Landless, M.B., B.Ch., M.Med., F.C.P.(SA), F.A.C.C., is ICPA executive director and associate director of Health Ministries.

Send your questions to: Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20905. Or you may send your questions via e-mail to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.