Read an Excerpt
Dr. Rob's Guide to Raising Fit Kids
A FAMILY-CENTERED APPROACH TO ACHIEVING OPTIMAL HEALTH
By Robert S. Gotlin
Copyright © 2008
Robert S. Gotlin, D.O. and the estate of Lois Wyse
All right reserved.
Chapter One fitness is a family affair: RAISING FIT KIDS IN AN EXPANDING WORLD
Okay, Dr. Rob, we want our kids to be in shape for life, but what can parents do?
The first step is the most important: take time to consider your family's lifestyle. Are you always on the run? Rushing from a hockey game to a school play to a quick dinner? Hurrying to get something out of the fridge and into the microwave?
When most of us see an overweight child or adult we immediately think, "Wow. I'll bet junk food is responsible for their weight problem." In our rush to judgment we are only too willing to blame candy bars, potato chips, sodas, and plates of pasta for out-of-shape bodies.
Junk food, however, isn't the only reason we pile on pounds. Junk lifestyle plays a big role, too. We are truly a "sit-down society."
From the minute we leave the house in the morning, heading for school or work, until we arrive home in the evening, we sit-on the bus or train or in the car. Our kids sit at school all day long, and most of us have sedentary jobs. We come home exhausted, and all we can think about is relaxing in front of the television.
Studies have shown that there is a direct correlation between the hours of TV watched and a child's weight. It's important that we make our children understand we are not pushing them to exercise-but rather encouraging the healthy habits that will give them a lifetime of fun and energy. Exercising need not be a chore.
The most avoidable statistic is that more than 10 percent of children between the ages of 2 and 5 are overweight. Why this alarming increase?
It's not just about food. Think back to your own childhood. Your parents probably dictated the amount of television you could watch. Perhaps, as a parent, you also set time rules regarding homework and watching TV. But how does your child spend the rest of her free time?
When you were a child, chances are you went outside to play with your friends, because you lived in a neighborhood where no one worried about dangers such as child molestation. You rode your bicycle, walked, or roller-skated to meet your friends.
Many of us grew up in the "free-play" era, when you would pick up your baseball glove, grab the football, don your sneakers, and go to a nearby park. You either walked or rode your bike, yelling back to your mom, "See ya later." Without cell phones, this was the last communication you had with home until you came back for dinner. Mom went about her business and household chores, while you ran free and played with your friends.
It's different today, although it need not be. Fear has most of us closely linked to our children, and rightfully so. Concerns for safety are universal, in crowded cities and suburbs alike. We want to be sure our children are protected. For many of us, the best way to do this is to involve them in supervised play either at home or at the home of a friend. The backyard is generally as far as they are allowed to roam.
Playing with friends often means sitting at the computer text messaging or e-mailing the latest homework assignment laced with jokes. Today's youngsters average 5 1/2 hours every day sitting in front of a TV, video game, or computer. This leaves little or no time for physical activity. Gone are the days when we ran to a friend's house to pick up something we needed or walked to the library. Author Rick Reilly says that kids today play "Sit on Your Can" not "Kick the Can." Most parents can remember pick-up ball games at a nearby field-today, those fields are covered with oversize houses-and consequently, we are looking at a lot of oversize kids.
If you think there's no cause for real worry because your kids are getting a full dose of physical activity at school, better check their schedules. According to an American Academy of Pediatrics Policy statement published in May, 2006, the availability of regular physical activity in school-aged children is at a critical (low) level. Although 80% of states do have physical education requirements for school children, almost half of them have exemptions from participation. The National Association of State Boards of Education recommends 150 minutes/week for elementary school students and 225 minutes/week for middle and high school students. A recent study of elementary school students revealed a total of 66 minutes/week of school-based physical activity, less than half the recommended amount.
Instead, school curricula are flooded with academic challenges, a focus on standardized testing, and blatant disregard for the essential foundation of academic success-physical fitness. Study after study supports the concept that physical fitness and scholastic success are directly linked. The better a child's level of physical fitness, the better his performance on standardized testing.
The result of this lack of exercise is evident not only in academic performance. Many of us who work with young children see the physical results as well. William Whitener, the artistic director of the Kansas City Ballet, reports that his colleagues have noticed that children beginning dance instruction have less coordination, rhythmic skills, body awareness, muscle tone, and stamina than their counterparts did 10 years ago. According to Whitener, "We attribute this overall decrease in physicality to the lack of exercise among youngsters. Children today are behind before they begin."
Our sit-down lifestyle often leads to severe obesity, which has the potential to kill us and our children. "The American lifestyle is toxic," said Dr. Karen Rubin, a pediatric endocrinologist and professor of pediatrics at the University of the Connecticut School of Medicine, in an interview with The New York Daily News. The increase in severe obesity-defined as being at least 100 pounds overweight-has quadrupled since 1986. Instead of 1 in 200 diagnosed as "severely obese," we now have the diagnosis in 1 of every 50 children. The Centers for Disease Control has reported that one in three kids born since the start of the new century will develop diabetes and is a potential candidate for heart disease, sleep apnea, gallbladder disease, and depression. All of these health concerns are rooted in childhood obesity.
A recent body of evidence also suggests that kids who do not get enough sleep tend to be hungrier and prone to weight gain. Children who get less than 10 hours of sleep per night often have an increased appetite, because lack of sleep alters the "hunger controlling" hormones naturally found circulating in the body. Forgoing a good night's sleep has adverse effects on many aspects of health and well-being.
How do you know if your child is obese? The old-fashioned way was to look at so-called "ideal body weights," which can be calculated by taking into account height and weight. Today, however, we have a more sophisticated measure called the Body Mass Index or BMI.
What is BMI and how do we measure it? The Pediatric BMI is a correlation of how a child's weight compares to his height. The higher the BMI, the heavier a child is for his height. The Pediatric BMI percentile calculation is a tool used to assess how a specific child's BMI compares to other children of the same age and gender. For example, if a child's BMI is reported as the 50th percentile, this means he is heavier than 50% of other children of the same age and sex. If the child's BMI is reported to be the 75th percentile, he is heavier than 75% of other children of the same age and sex. Many BMI calculators are available on the Internet. Simply plug in your child's values (height, age, and weight), and you will get his BMI. The interpretation of these percentiles is as follows:
If your child's BMI is reported to be:
<5th percentile: The child is underweight.
5th-85th percentile: The child is of "normal" weight.
86th-95th percentile: The child is at risk for being overweight/obese.
>95th percentile: The child is overweight.
Studies suggest that 60-65% of adults are overweight or obese, and-even more alarming-a recent survey of New York City schools revealed that 43% of the children in kindergarten through fifth grade are overweight or obese.
* For the first time in modern history, the average life expectancy of children is declining!
Diabetes, hypertension, and cancer are now a concern for kids because of the surge in childhood obesity. It's time to get kids "fit for life," so let's get them up and moving toward a healthy lifestyle.
Fitness Is Not Only for Children
Look around you. Overweight children often have overweight parents, and although heredity plays a role in bone structure and body type, lifestyle also contributes to the plump as well as the fit next generation. Adults spend too much time on the couch telling kids how to have better bodies and, of course, no child likes being singled out for his faults.
You have to do more than stand over a child and nag. As bad as you might think your child looks, your child thinks he looks even worse. We all know that obesity increases a person's risk for a number of serious conditions: diabetes, heart disease, stroke, high blood pressure, and some types of cancer. But what about the emotional problems that increase with the extra pounds?
Body image is so much a part of our culture, and it develops at such an early age, that most doctors are concerned about the overemphasis on the perfect body and the ways it distorts children's perceptions of themselves.
It isn't just 10- to 12-year-old girls who are worried about having supermodel bodies. One hot day, I told the boys on a basketball team I coach that we needed to divide up into two groups for a practice game. They all had different color shirts on, so I decided to have half of the players wear their shirts and the other half play with their shirts off-like the old game of "shirts and skins." Much to my astonishment, my seemingly innocuous suggestion was received by some of the boys with great distress. A few of those chosen to be on the "skins" team were reluctant to remove their shirts, and I realized they were embarrassed because they were overweight.
Recent studies suggest that obese children believe their quality of life to be as low as that of cancer patients on chemotherapy. Obese children have difficulty with any exercise or sports activity, and they often suffer fatigue and sleep apnea, as well as feelings of inferiority.
Tips for Change
Don't announce to the family that "we" are going on a diet. Slowly and quietly make the necessary dietary changes. Enforce the notion that it's essential to consume healthy food, rather than engage in endless discussions about dieting.
Don't rush out and sign up your kid for multiple sports programs, thus placing the total fitness burden on them. Stand back and look at yourself and your children as a family. What are you doing together these days? When was the last time you all hung out as a group? Kids aren't the only ones who need play dates. Families do, too.
* Beginning today, you can eliminate your "fat family" and begin to create your fit family!
Most families have two working parents, often out of financial necessity and, with the possible exceptions of family vacations or holidays, our time together is limited. Begin by arranging specific times for the entire family to get together, with the goal of making fitness a family affair. Isolating an overweight child and making him feel like he has special needs will only reinforce guilt feelings about his body and doom any program to failure. Let's turn off the TV, leave the computer on "sleep," and try a few family projects to get everybody in step!
The Family Walk
Begin with a once-a-week walk on the weekend. The idea is to meet consistently as a family and walk together. In the beginning, it's a good idea to have a destination in mind-it doesn't matter if it's only a stop at the drugstore to buy a magazine. Reaching a destination means accomplishment and gives satisfaction.
Speed walking should be your next goal. Begin to pick up the pace, but just remember it isn't a contest. No one needs to "win."
The Paired-off Walk
If only one parent and child is available, that's okay. Try walking after dinner when weather and daylight permit. I know it's tough when you finally get your child all to yourself, but stay away from questions like, "Why didn't you turn in your English paper on time?" Don't turn the walk into an inquisition. This should be a time to enjoy one another, and if no one talks, that's okay, too.
Other Family Stuff to Do Together
Washing the family car. Every kid is interested in this activity, because they're all waiting for the day they get a license and can express their independence by driving.
Walking the dog. A boring job, but somebody has to do it-and it doesn't have to be done alone. Remember, 30 minutes of walking every day (yes, even walking the dog) burns 100 calories.
A little aerobic exercise. Do you live near a park? Is there a school athletic field nearby? Fast-walk there with your child for a game of Frisbee, catch, or a light run around the park or track perimeter-end with a few push-ups or jumping jacks. Even though it's a workout for the kids' benefit, you'll be amazed at how much better you will sleep.
A trip to the mall. No exercise there? Wrong. All you have to do is park at the end of the mall where you're not shopping, and start walking.
An elevator ride. How can an elevator ride provide exercise? It can if you leave the elevator for others and take the stairs. If you're going to the twelfth floor, press 10, and walk up the last two flights. Pick a floor between one and ten, and keep changing it for variety and cardiovascular strengthening.
Gardening. Try weeding, mowing the lawn, or planting something. Your garden isn't the only thing you'll improve.
Martial arts classes. Classes are probably available in your neighborhood, and they are particularly good for bonding between child and parent.
Family exercise sessions. Take at least 30-45 minutes each week to exercise together as a family doing sit-ups, push-ups, pull-ups, jumping jacks, and weight training. (Working out with weights is actually good for young children; for complete information on safe weight training, see Chapter 3).
Where's the fun? Probably right in your own backyard, along with all the other good stuff in life. Parents are good at scheduling learning activities, but in addition to computer, dancing, music, and language lessons, make sure there's time set aside for play-good old-fashioned running and jumping with other kids.
Free play is best for your child, and games like tag, hide-n-seek, or choose-up sides contests-games that require fairly continuous movement-are good choices. If you gather a group of friends in a park or playground and give them a ball or two, they will figure it out. Before too long, they will be playing a game you might never have heard of before and having loads of fun.
Adults need to lighten up on their approach to family health and think about having a good time. Send your children out to play dressed appropriately for the weather-not for the blizzard that might come 4 months from now. Remember, when they are running around, they get warm, so don't overdress them either. When they are all geared up and raring to go, just give them a peck on the cheek, pat their sweet little heads, and tell them to go out and have a good time. In other words, relax. Let kids be kids.
Excerpted from Dr. Rob's Guide to Raising Fit Kids by Robert S. Gotlin Copyright © 2008 by Robert S. Gotlin, D.O. and the estate of Lois Wyse. Excerpted by permission.
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