Paralleling the increasing trend toward obesity in children throughout the world, this problem is on the rise in Cayman.
Bethany Smith, community dietician at Cayman Islands Hospital, believes overweight children are becoming more of an issue here.
‘We are no different from the rest of the world. The levels of overweight are increasing,’ she said.
Several factors are contributing to the problem, Ms Smith explained.
For one thing, the people here are influenced by North America. ‘We get a lot of our foods from there and we are consuming more fast food,’ she said.
Ms Smith pointed to the great increase in portion size over the last few decades, and how the public is looking for value by getting more food for their money.
A study done in 2001 dramatically illustrates how portions have changed, according to Dr. Leslie A Lytle, a professor at the University of Minnesota’s Division of Epidemiology and Community Health.
Dr. Lytle cited the study at a recent conference on Preventing Childhood Overweight and Obesity held in Iowa.
In 1957, a typical fast-food hamburger contained 1 oz. of cooked meat, compared to 6 oz. in 2001. Soda was usually served in 8 oz. cups 48 years ago, but in 2001 the typical size was 20 oz.
Food got bigger at the movies as well. Popcorn started at three cups a portion in 1957; a medium serving in 2001 equalled 16 cups, according to the study.
Changes such as these have taken their toll on children in the US.
She explained how the percentage of US children, aged 6-11, who were overweight has increased over the last four decades.
The situation is similar in Cayman. Based on body mass index data collected during school health screenings, this figure has been increasing, Ms Smith explained.
The latest statistics available, from the 2003-2004 school year, deal with children aged 10 to 13.
Any child with a BMI in the 85th percentile or higher is considered at risk for overweight, and at or above the 95th percentile is classified as overweight.
Out of the 232 children measured, 14.7 per cent were found to be at risk for overweight and a further 24.6 per cent were classified as overweight, for almost 40 per cent combined of those tested.
Part of story
These numbers only tell part of the story, however. A BMI that falls below the 85th percentile does not mean that the child’s weight is at a healthy level, Ms Smith explained.
‘If the child is approaching the higher end of the range, parents need to be more vigilant about maintaining their child’s weight rather than allowing them to continue to increase to a higher percentile of BMI,’ she said.
In a similar screening of 129 schoolchildren performed in 1997-1998, 16.3 per cent were at risk for overweight and 20.9 per cent were overweight.
‘Based on these statistics, in light of statistics from other countries, we can conclude that we are not exempt from the problem of overweight amongst children and adolescents,’ Ms Smith said.
Even though the increase is not great when comparing the two screenings, there is still cause for concern, according to Ms Smith.
‘The overall numbers are increasing, even if the rate isn’t as high as we originally thought it would be. In addition, we are looking at a specific age range.
‘If we had looked at older and younger children and collected more data, we could have had more conclusive findings,’ she said.
Ms Smith added that with more data, the numbers might more closely resemble those of the US.
Local paediatrician Dr. Virginia Hobday has also noticed the increasing trend toward overweight children in Cayman.
She is alarmed by the BMI data collected during the entry screenings for school children, which indicates a high percentage of youngsters either at risk of overweight or already overweight.
‘I thing that 40 per cent is way too high. We need to seriously take note of that. It’s a very worrying statistic,’ she said.
Pay attention
Not every parent that comes to her office with an overweight child realises there is a problem.
‘Parents are often surprised to find out the child is overweight, but if a child is too thin, they will ask how they can gain weight,’ she said.
The doctor is concerned because overweight and obese children can develop serious health problems.
‘There used to be just Type 1 diabetes in children, but the number of children with Type 2 diabetes is increasing. This is related to diet and obesity. It’s almost like a new phenomenon,’ she said.
Type 2 diabetes is usually caused by being overweight, though there can also be a genetic predisposition to this disease.
In addition, this same age group is developing hypertension, another serious health problem. Dr. Hobday discusses these risks with parents of overweight children
‘I wouldn’t be doing my job if I didn’t explain the health ramifications of obesity,’ she said.
She talks in a different way with the children to avoid alarming them, but adds, ‘We have to be realistic, clear and honest with children.’
Manageable targets
The doctor also tries to keep targets manageable for the children.
‘We need to accept that we may not achieve weight loss but we can prevent further weight gain, and anticipate the BMI will reduce as their height increases,’ Dr. Hobday explained.
Possible reasons for this escalating health issue are varied. Ms Smith speculated on some of the likely causes.
Lack of exercise is one factor. There seem to be fewer opportunities for physical activity, Ms Smith explained.
‘There is not as much emphasis on exercise, not as much walking or bicycling.
Dr. Hobday added that it is never too early to start getting children involved in sport.
‘Parents should realize sport is an important part of children’s lives,’ she said.
Heredity, however, also plays a part in causing obesity. The genetic makeup of an individual could affect his/her weight, Ms Smith explained.
‘Genetics affect body shape and size as well as the places in the body where fat is stored,’ she said.
Dr. Hobday agreed that genetics and behaviour are the two main factors leading to obesity.
‘Only 1 per cent of obesity is disease-related,’ she said.
She stressed the importance of proper nutrition
‘Calories in equal calories out is the basic equation that underpins everything.
‘Nutrition — what you eat — and exercise are the only two things that are going to fundamentally affect your weight,’ she said.
Telling message
Ms Smith explained that a major part of her job is to get this message out. As a community dietician, she performs a lot of outreach work, visiting schools and attending different public health events.
‘We go to the schools upon request and talk to assemblies and individual classes,’ she said.
Ms Smith discusses the food pyramid, food groups and portions with the children.
‘The kids respond to the food models, which are very colourful and look real to them,’ she said.
How children eat is almost as important as what they eat, she added.
‘The hormonal signals from the stomach to the brain take 20 minutes to register fullness.
‘By eating slowly and chewing well, it helps you to realise you are full,’ Ms Smith said.
The dietician is looking to change not only eating behaviours, but also exercise habits.
‘Children need about 60 minutes of daily moderate activity. Ideally, exercise should be a natural part of your life,’ Ms Smith said.
Changing lifestyles have contributed to the lack of exercise, she explained.
‘After school, the kids come home, have a snack, which usually includes sodas or sweet drinks, and then play computer games or watch TV,’ Ms Smith said.
A program dealing with all facets of this health issue would be very helpful, she added.
‘We need multidisciplinary support – dieticians, exercise specialists, behavioural therapists.
‘We have to look at such things as the psychology of food and food choices. Schools would also be important to this program. The more support we get, the more successful the program will be,’ she said.
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