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Health & Exercise Forum

Obesity Symposium Part 1 of 3: Childhood Obesity

Mar 18, 2013

Dr. Mackarey's Health & Exercise ForumThe Commonwealth Medical College presents: The 1st Annual Keystone Program “Obesity Symposium 2013”

In an effort to address the Keystone State’s growing problem with obesity, TCMC with host the 1st Annual Keystone Program – Obesity Symposium 2013 on April 6, 2013.

The World Health Organization has classified obesity as a chronic disease and determined that it is reaching epidemic proportions, not only in the United States, but globally. Moreover, closer to home, the Pennsylvania Department of Health has determined that PA ranks 17th among all states in the country for percentage of obese residents.

The purpose of the symposium is to provide strategies for health professionals and students to prevent childhood and adult obesity recognize risk factors and discuss various treatment options such as behavioral, pharmacological, and surgical.

“Health & Exercise Forum” will dedicate the next three weeks presenting columns on topics related to this local, national and international epidemic.  



People have theorized for many years that obesity must be genetic. Scientific research has validated this theory and more importantly, a recent study has shown that while there is an obesity gene that may predispose one to obesity, one can control the outcome with exercise. The fat mass and obesity gene (FTO) is linked to a high body mass index according to a new study in the Archives of Internal Medicine. More importantly, this study found that exercise can offset a genetic predisposition for obesity. Aerobic exercise 30-45 minutes 3-5 times per week coupled with mild weight training and other physical activities can overcome the FTO. With new knowledge, it becomes apparent that it is critical to promote a healthy lifestyle with exercise and physical activity at an early age to prevent childhood obesity.

Childhood obesity is defined as an excessive accumulation of body fat, as determined by skinfold measurements, when the total body weight is more than 25 percent fat in boys and 32 percent in girls. While some define it as a weight/height in excess of 120 percent of the ideal, skinfold measurements have been found to be much more accurate.

Childhood obesity has reached epidemic proportions in the United States. Moreover, childhood obesity is on the increase as found in a 54 percent increase in body fat measurements among 6-11 year olds since the 1960’s. The American Medical Association and American Physical Therapy Association have taken active rolls through their memberships to educate, advise and treat children with weight problems:

Childhood Obesity as a Medical Problem

Obesity increases with age and its prevalence among obese children will continue to be obese with age. Childhood obesity is the leading cause or is associated with: hypertension, Type II diabetes mellitus, coronary heart disease, lower extremity joint stress and pain, lower self-esteem and other psychological problems.

Causes of Childhood Obesity

As with adult obesity, childhood obesity is most often caused by multiple problems including: nutritional, psychological, familial, and physiological.

    1. The Family: The risk of becoming obese is very high for those children with two obese parents. Strong genetic factors as well as parenting habits of eating and exercise may play a role.
    2. Low-Energy Expenditure: The average child in this country spends several hours watching TV or playing video games. Childhood obesity is greater among those who exceed this average not only because of low-energy expenditure, but also due to the consumption of high-calorie snacks and drinks while watching TV. Previous generations spent this time engaging in physical activity. Only one-third of grade-school children have daily physical education in school.
    3. Heredity: Not all children who eat badly and lack physical activity are obese. As shown in the Archives of Physical Medicine study the FTO gene has shown that there are other causes for obesity, such as heredity.


Treatment of Childhood Obesity

Weight loss is not the primary role of a good childhood obesity program. The goal is to limit or stop weight gain so the child will eventually grow into their body weight over a period of many months or years. One study suggests that it requires 1 ½ years of body weight maintenance for every 20 percent excess in ideal body weight for a child to ultimately attain ideal body weight.

1. Physical Activity

Increasing physical activity or engaging in a formal exercise program is essential to burn fat, increase caloric expenditure to lose and/or maintain weight. However, studies show that exercise alone is not nearly as effective as when it is combined with proper nutrition/diet and behavior modification. Physical activity is also critical for the health of the child. Blood pressure and lipid profiles improved in children/adolescents who engaged in 50 minutes of aerobic exercise, 3 times per week, even when weight loss was only minimal. In view of this, I recommend 45-60 minutes of exercise and physical activity a minimum of 5 days per week and prefer 7.

Use technology to promote fitness with physically active video games such as the Dance, Dance Revolution (DDR) or Wii Fitness to excite your kids into healthy activity. A recent study at the Mayo Clinic has found that children expended significant energy when they play video games that require activity, such as the “NintendoR Wii.” The study found that kids expended three times more energy as compared to traditional video games played while sitting or when compared to watching TV while walking on a treadmill. There may be hope for our kids!

Also, some exercise and fitness clubs specialize in programs exclusively for children such as Fitwize 4 Kids. It is a kid’s health club that offers an assisted 45 minute program featuring cardio, strengthening, flexibility, agility and nutritional counseling for ages 6 ½ to 15.

2. Diet Management

Extreme dieting and fasting is not appropriate for children. It is emotionally stressful and physically harmful to the growth and development of a child/adolescent. A balanced diet with moderate caloric and portion restrictions coupled with exercise and counseling is the proper combination.

3. Behavior Modification

Behavioral strategies are found to be very successful in children/adolescence. Self-monitoring and keeping a record in a journal of food intake, activity and exercise are helpful. Also, rewards and incentives can be effective. Parent/child counseling programs are most effective.

In conclusion, childhood obesity is a serious epidemic. It is physically and emotionally stressful for the child/adolescent and family. This problem requires a comprehensive team approach including: physician, educator, dietitian, psychologist, and exercise specialist. Lastly, to be successful, it must be a lifetime lifestyle change 7 days a week with regard to diet and exercise, not a 3 to 6 month fad. It must be a long-term program with long-term goals.


Sources: Archives of Physical Medicine, 2008, Vol 168, 1791 – 1797

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune. Next Week: Bariatric Surgery for Obesity Part I of II.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.