CORONAVIRUS (COVID-19) RESOURCE CENTER Read More
Add To Favorites

Child obesity is lower in New York. Here's why -- and why this health disorder still matters

Buffalo News - 9/24/2022

Sep. 23—Federal researchers gathered top pediatric surgeons at a Chicago hotel in 2004, alarmed that a growing number of children were coming down with adult-onset diabetes, high blood pressure and other chronic diseases typically known only to strike those much older.

The children in question were grossly overweight. The National Institutes of Health needed to find treatments, but pediatric specialists weren't trained to handle them.

"You didn't go into pediatrics to operate on 500-pound patients, so it was hard to get the kids taken care of," said Dr. Carroll "Mac" Harmon, among the first five specialists who answered the NIH call for pediatric surgeons interested in learning how to perform bariatric surgery and take other steps with teens whose weight threatened their health.

It was an important point in a decadeslong struggle that continues to threaten American children, including in New York.

"Over the last 30 years, obesity has reached epidemic proportions, not only in New York State, but across the country," State Health Commissioner Dr. Mary T. Bassett said. "As a result of inequitable access to healthy foods, including a glut of low-nutrient, high-calorie foods, low-income Black and Latino populations are disproportionately affected by obesity."

New York fares better than four of every five states when it comes to the percentage of children deemed obese, but the numbers remain high enough to cause concern.

Roughly one of three high school-aged children across New York is obese or overweight, as well as almost two of every three adults, federal statistics show.

Those like Harmon on the front lines of health care since the 1980s report a growing number of patients today who weigh more and have greater health challenges than a generation and longer ago.

"Of the kids I've operated on, half of their parents have had bariatric surgery," said Harmon, since 2014 the chief of pediatric surgery and surgical director of the Healthy Weigh program at John R. Oishei Children's Hospital in Buffalo. "The parents show up and say, 'I don't want my teenager to go until age 35 suffering like I did.' "

The numbers

Child obesity is costly for families and communities across the country, including New York, where the obesity rate for those in high school ranks 39th among states, according to the Centers for Disease Control and Prevention.

The ranking is one piece of good news.

So, too, is the percentage of children age 2 to 4 in New York State's food benefits program Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) who are obese. It has fallen during the past decade, from 16.1% to 13.6%.

But things get murkier with a closer look.

New York can boast a lower obesity rate for high-schoolers than most other states — 13.4% compared to 20% or more than the highest states of Mississippi, West Virginia, Arkansas and Tennessee — but when combined with the rate of overweight upper-grade students, 16.3%, the state sits in the middle of the pack when both excess weight categories are considered.

Worse still are trend lines for adults.

A decade ago, 59.8% of New Yorkers aged 18 and older were obese or overweight. The number stood at 63.3% in 2020, the most recent year for which national figures are available.

Public health officials brace for more bad news next month, when the federal government provides an update that will include figures from earlier in the pandemic.

"The Covid-19 pandemic underscored the health risks of obesity, making clear that action is needed to reverse these trends," Bassett said.

No end in sight

As it is, things have gotten so bad during the first two decades of this century that the term "adult-onset diabetes" was changed to Type 2 diabetes to reflect that a growing number of children have come down with the condition.

Eight years ago, Harmon and his multidisciplinary team at Oishei Children's opened the Healthy Weigh clinic one day each month to see young patients who grapple with obesity. That soon expanded to twice a month, then eventually once a week.

"It's now twice a week and we need more," he said. The clinic has a three-month waiting list.

Similar dynamics have played out across the state and country.

Dr. Leonard Epstein, SUNY distinguished professor in the University at Buffalo departments of Pediatrics, Community Health and Health Behavior, and Social and Preventive Medicine, said the changes are connected to the food and activities children experience today.

"Kids have a lot more access to sedentary things," Epstein said. "They're less physically active. The kind of foods that are available have changed dramatically over the last 20 or 30 years."

Genetics causes are rarely to blame for children and adults to becoming overweight and obese.

"It's a behavioral disorder," said Epstein, who has led research since the 1970s, first at the University at Pittsburgh, and during the last two decades at UB, to observe how family-based based treatment can turn the tide because parents learn to model healthy behaviors and lose weight, too.

His evidence-based approach involves pediatricians, nutritionists, exercise physiologists, psychologists and social workers all used to working with children and trained to nurture nutritional behavior change. Group trainings last three months or more with aims to create lasting weight loss for parents, children and siblings.

Epstein, who pioneered the family-based approach to weight loss, in 2017 was awarded a five-year, $8.8 million grant from the National Institutes of Health to start making such successful family-based weight-loss programs more widely available. The work has taken place in primary care offices in Buffalo and Rochester in Western New York; Columbus, Ohio; and in Washington University-tied practices in St. Louis, Mo. Pediatric researchers at the University at Tennessee also have duplicated the work.

How we got here

The modern American way of life — packed schedules and lots of screen time, chased down with processed food, often on the go and loaded with too much fat, sugar and salt — drives the obesity epidemic.

A lack of consistent access to healthy, affordable food needed for active living helps explain the obesity epidemic, the New York Health Foundation reported last month in a survey of more than 1,500 state residents.

One in 10 New Yorkers — nearly 2 million people — didn't have good food access before the pandemic and inflation bore down on the state, creating related health care costs that topped $3.4 billion a year, the nonprofit health care advocacy foundation estimates.

Only 14% of survey respondents who were food insecure reported excellent health. Nearly 70% of them reported at least one chronic physical or mental health condition. The vast majority said they had trouble cooking at home and counted on cheap, nonperishable foods to sustain their diets.

Julia McCarthy, the foundation senior program officer who led its food and health survey, pointed to New York's food benefit programs — including Supplemental Nutrition Assistance Program (SNAP), WIC and Pandemic Electronic Benefit Transfer (P-EBT) — as efforts that have softened the blow during the pandemic compared to states where obesity rates run higher.

The report advocates for a continuation of those programs, permanently extending free universal school meals statewide and launching more "Food Is Medicine" programs to give parents and their children more tools to address obesity, hunger and health.

Meanwhile, the state health department has launched programs to encourage breastfeeding, healthier eating and more school, individual and community exercise.

Sara Alexander, a registered nurse and registered dietitian who helps run the Healthy Weigh program, said a combination of those efforts, particularly in underserved neighborhoods, helps explain why New York has a lower obesity rate than most states.

Efforts to extend free universal school meals have stalled in the U.S. Senate as the pandemic subsides, though New York, with support from the foundation, is among states working to secure the program in the absence of federal action.

Researchers reported in July 2020 that children in poverty who availed themselves of free breakfast, lunch and smart snack programs funded through a 2010 Healthy, Hunger-Free Kids Act lowered their obesity risk by 47%.

"School meals are among the healthiest meals children eat each day," McCarthy said.

Other support

Epstein and Harmon are among those who continue to lead efforts to lighten the load for the most weight-challenged of families in Western New York and beyond.

"It's great that we have surgical treatments, but that's not the first line of defense," Epstein said. "Obviously, if we could get people to eat healthier and be more active, it would change things drastically."

Epstein and his team of researchers have used a series of clinical trials around the world to improve and expand it.

"We see this as a family problem, not as a child problem, and we target the parent as well as the child," Epstein said.

The Columbia University Vagelos College of Physicians and Surgeons in Manhattan uses the same approach, which remains rare, he said.

Parents who participate in the UB group program tend to lose 20 or more pounds while children typically drop about 20% of their body weight.

More importantly, Epstein said, is that half of participants remained at a more normal weight a decade after treatment.

"It's more effective for both parent and child," he said. "The main tenets are the positive parenting, keeping junk foods out of the home, modeling healthy behaviors and reducing sedentary behaviors. All of those things are easy to tell people to do, but hard to implement."

It's worth the effort, especially now.

"Obviously, people are busier now. It can be harder for parents to spend as much time as they used to with their kids," Epstein said. "But it's basically the same principles. If you don't bring unhealthy food in the house, you're not going to eat it."

___

(c)2022 The Buffalo News (Buffalo, N.Y.)

Visit The Buffalo News (Buffalo, N.Y.) at www.buffalonews.com

Distributed by Tribune Content Agency, LLC.