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EXERCISE IS A CRITICAL COMPONENT IN THE CURE!

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. Childhood obesity is defined as having a body mass index (BMI) at or above the 95th percentile for age and sex in children aged 2 and older.

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 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 as a minimum of 5 days per week and preferably 7… walk, run, bike, swim, play tennis, pickleball, soccer, and walk when you golf.
    • Use technology to promote fitness with physically active video games such as the “GET STRONG” Kids Workout and “Kids Daily Exercise” that children expended significant energy when they play video games that require physical activity. Many studies have found that kids expended three times more energy than 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 personal trainers and fitness clubs specialize in programs exclusively for children such as “My Gym Scranton” on Birney Avenue, Scranton.  
  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: family, physician, educator, dietitian, psychologist, physical therapist and other health and exercise specialists. Lastly, to be successful, it must involve the entire family and be a lifetime lifestyle change 7 days a week regarding diet and exercise, not a 3-to-6-month fad. It must be a long-term program with a long-term goal!

Sources: World Health Organization (WHO), Archives of Physical Medicine, 2008, Vol 168, 1791 – 1797

Visit your doctor regularly and listen to your body.     

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

A routine visit to your primary care physician can be overwhelming. In addition to countless forms about insurance and privacy, endless questions about your medical history can be exhausting. A plethora of questions about your medical history is followed up by the health conditions of your closest relatives. While it may seem intrusive and laborious, the health conditions of your parents, grandparents, siblings, aunts and uncles can help them know what to be on the lookout for with you. For example, if your mother has high blood pressure, they might want to keep a closer eye on yours.  Both nature (your genes) and nurture (your family’s lifestyle) can have an effect on your health -- and you get both from your parents.

It is important to disclose any ongoing conditions (like diabetes or asthma) or serious illnesses (like cancer or a stroke) your parents, grandparents, and siblings have or had and how old they were when the health problem started. If any of them have passed away, let your doctor know their cause of death and how old they were when they died. They also may ask about things like your family’s lifestyle or diet, because relatives tend to have these in common.

Health Conditions That Run in Families

Just because a close relative had a certain condition or illness, that doesn’t necessarily mean you will have it. However, your chances are slightly higher than other people’s. Some health issues that can be passed down include:

Ethnicity and Health Conditions

Ethnicity refers to the cultures, customs and lifestyle choices of certain groups more than in the general population. Your doctor may ask about your race because people who have roots in certain parts of the world are more likely to have some conditions. For example, African-Americans have a higher chance of having sickle cell anemia and high blood pressure, Caucasians have a higher incidence of cystic fibrosis and Jewish people from Eastern Europe are more likely to carry the BRCA gene mutation and be born with Tay-Sachs disease.

Finding Your Health History

Many people do not know much about their family medical history for a variety of reasons.  If possible, ask your closest relatives about their health and the health of other family members such as; aunts, uncles, or cousins. If you’re lucky someone may have kept a family tree, baby books, or other keepsakes that could be of value. If that doesn’t work, there are other options in an internet age;

Help Online

The U.S. Surgeon General’s office has an easy way for you to collect this kind of information. It’s called My Family Health Portrait. It helps you make a kind of family medical tree that you can share with relatives and download to take to your doctor.

Getting Records

Information about your relatives can often be found in death certificates or medical records such as age at death, cause of death, and ethnic background. The rules are different for each state, but close family members are often allowed to order copies of these. Obituaries, which are often posted online, may also have some information. 

Ancestry Research

For those who don’t know much about your relatives and don’t have time to research it on your own, there are companies that can help fill out your family tree. Once you know the names of your relatives, you can try to contact them or find obituaries or death certificates.

Genetics

For some, it may be helpful or necessary to have genetic or DNA testing performed. A conversation with your primary care physician will help make an informed decision.

For Those Without a Detailed Medical History

Not everyone will be able to provide a thorough and comprehensive medical history for their physician. For example, adopted children or those who lost parents at an early age often lack access to a strong family history. Do your best to talk to your doctor about the information you do have or tell them that you don’t know much about your family health history. They can help you sort through it and maybe even tell you where else to look. Even if you’re missing some facts, any information you have can be useful.

SOURCES: WebMD; National Institutes of Health

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

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: drpmackarey@msn.com

For all of Dr. Mackarey's articles visit: https://mackareyphysicaltherapy.com/forum/

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 GCSOM