When she was a toddler, getting Agusta Gudmundsdottir to eat was never a challenge. For breakfast, she'd eagerly down a full bowl of sweetened cereal with milk and a glass of apple juice. Then it was off to the daycare center, not far from her Miami home.
Lunch, prepared by Mom, was usually a butter sandwich and a cookie, followed by more cookies during midafternoon snack. Once home, she'd munch on a slice of buttered bread before dinner, which was often pasta.
And dessert? "Another cookie," says her father, Gudmundur Palmason, "since she wouldn't stop begging until we gave her one."
By age 4, Agusta weighed 68 pounds (33 more than the average for her age) and stood 45 inches tall (a few inches above average). But the sugary cereal, cookies, and buttered bread weren't the only things responsible for her chubby cheeks and round tummy: At an age when many kids can't seem to sit still, Agusta spent most of her free time in front of the television.
It became clear that her extra weight was no longer baby fat. "Since we're with her every day, we didn't really see how much weight she'd gained," says Palmason. "It was my mother -- who hadn't seen Agusta in five months -- who made us realize that she was way too heavy."
Agusta's not alone. Childhood obesity is a significant and growing problem in this country. Between 1980 and 1994, the number of obese children in the U.S. almost doubled, with nearly 14 percent of all children ages 6 to 11 now considered overweight. There's also been a notable jump in overweight 4- and 5-year-old girls, according to the National Center for Health Statistics.
Many experts say these figures are actually low, because they only include children whose body mass index (BMI) -- defined as how much space a person's body takes up -- is in the 95th percentile (meaning that, like Agusta, their body mass is greater than that of 95 percent of their peers). By including children whose BMI is in the 85th percentile -- still too heavy, according to many experts -- the number of overweight children jumps to 22 percent, or almost one in four.
"Parents need to be aware of how serious a problem this is," says Marc Jacobson, M.D., director of the pediatric weight management clinic at Schneider Children's Hospital, in New Hyde Park, NY. Overweight children are at a slight but increased risk of many immediate health disorders, including kidney disease, hip and ankle problems, high blood pressure, high cholesterol, sleep apnea, and inflammation of the pancreas.
Obese children are nearly twice as likely to grow up to be obese adults. And a child who keeps the weight on through adolescence and into adulthood has a good chance of developing serious medical problems, according to Gerald Berenson, M.D., professor of medicine and pediatrics at Tulane University Medical School and a lead researcher of one of the longest-running studies on childhood obesity and heart disease. "By the time they're teens, many have the beginnings of heart disease or diabetes," he says. Early puberty -- common among both overweight boys and girls -- has been linked to breast cancer in women later in life. And cancer of the ovaries, uterus, colon, rectum, and prostate are also more common in obese adults.
Studies also show that overweight kids ages 6 and older tend to have fewer friends, are less involved with extracurricular activities, are more depressed, and have lower self-esteem than their thinner peers.
Laura Muha writes frequently about health and nutrition.
The Biggest OffenderMost experts agree that lack of physical activity is the number-one reason kids become overweight. Many children simply aren't moving their bodies enough to burn off the calories they take in.
"Twenty years ago, parents would send their children outside after school, where they'd play hopscotch and climb trees until dinnertime," says William Dietz, M.D., director of the division of nutrition and physical activity at the Centers for Disease Control and Prevention and one of the nation's leading obesity researchers. "Today, they're inside playing video games or watching TV."
The difference is significant, caloriewise. A child who spends 60 minutes in front of the television will burn 60 calories; a child playing outside (running around, riding a bike) for an hour burns over 200. And kids watching TV, most notably in the after-school hours, are also exposed to a multitude of irresistible commercials featuring high-calorie foods, which may prompt them to snack, says Dr. Dietz.
But lack of exercise isn't the only reason kids put on weight. Family history plays a significant role too. "If a child is overweight, very likely at least one of the parents is as well," says Nancy Butte, Ph.D., an associate professor of pediatrics at the Children's Nutrition Research Center, at Baylor College of Medicine. And if both parents are overweight, the child's risk is even greater.
Researchers are still trying to figure out exactly when obesity is genetic and when it's due to kids picking up their parents' eating and exercise habits. Some say that often both factors are at work. "Genes can predispose a child to gaining weight, but whether he does or not depends a lot on his environment," says Leonard Epstein, Ph.D., head of the behavioral medicine laboratory at the State University of New York, Buffalo.
What's clear is that children's home environments -- and consequently families' eating behaviors -- have changed dramatically. Meals today tend to be eaten on the run and often consist of fat-laden convenience foods.
One New Jersey mom says that since she went back to work three years ago, "we just don't eat the way we used to. A lot of night we'll have McDonald's, pizza, or sandwiches -- something quick -- so I can take the kids to an activity." Her son Billy, age 12, is five feet tall and weighs 140 pounds.
"Often, it's more convenient to grab fast food or hand them a snack cake rather than prepare a meal or cut up some fruit," admits Susan Pirtle, a stay-at-home mom in Waverly, TN.
At 13, her daughter, Katie, was five feet eight inches tall and weighed 214 pounds, about 50 pounds more than her doctor said she should.
Although Katie had always been big for her age -- she weighed 8 pounds, 11 ounces at birth and was usually the tallest child in her elementary school classes -- it wasn't until fourth grade that she really started to put on weight. When she hit 96 pounds at age 9, her pediatrician suggested cutting back on what she ate. But Katie complained when her mom tried to give her smaller portions or an apple instead of cookies as an after-school snack. And she got her food fixes by sneaking treats and munching on pizza and chips at friends' houses.
Susan now believes the eating habits she instilled in Katie as a child set her up to become overweight. "Katie ate exactly what I gave her when she was little," she says. "If I'd given her fewer snack cakes she might not be skinny, but I don't think she'd have the problem she has now." She's trying to encourage better eating habits in her son, Kristian, age 7. "I buy those little bags of carrots," she says. "And if he wants soda, I say, 'No, you can have apple juice or orange juice. Which one do you want?'"
Juice intake, many parents may be surprised to learn, is actually a significant factor in childhood weight gain. A study published last year in Pediatrics, the journal of the American Academy of Pediatrics (AAP), found that preschoolers who drank a cup and a half of juice or more per day were nearly two times as likely to have a weight problem as those who drank less.
"I've seen kids drink 500 to 1,000 extra calories a day in juice," says Nancy Copperman, a registered dietician at Schneider Children's Hospital.
That's a lot, considering that a toddler who consumes 300 calories more than she burns off every day -- the rough equivalent of two cookies and two glasses of soda -- will put on five extra pounds in a year, experts say. Over time that adds up: If weight gain continues at that rate, by age 10 a child could be 50 percent overweight.
And the consequences aren't just physical.
"Kids as young as five or six know that to call someone 'fatso' is a way to hurt them," says Michael Loewy, Ph.D., an assistant professor of counseling and psychology at San Diego State University who specializes in weight issues.
In a 1995 study, researchers at Connecticut College showed silhouettes of thin, average, and fat children to 30 first graders, asking which child was the "good" one and which one they'd most like to have as a friend. "The majority said the thin child was the good one," says Joan Chrisler, Ph.D., who chairs the college's psychology department and led the study. "And most wanted to be friends with the thin child."
"When a heavy child comes home crying that 'so-and-so called me fat,' the parent might say, 'Well, honey, you shouldn't be eating so many snacks,'" Loewy says. "So the victim is then blamed for his or her own victimization."
A better response, Loewy suggests, is to reassure the child that people come in all shapes and sizes. "I can't stress enough the importance of instilling a sense of self-acceptance in kids," he says, adding that if a child feels good about himself, he'll be better able to cope with teasing.
Battling the BulgeOf course, while it's important that a child feel good about his body, it's also vital for parents to lay the foundation for their kids' lifelong good health.
"When it comes to weight control, parents often assume that what's good for an adult is good for a child," says Dr. Jacobson. "But doctors rarely recommend that an overweight child lose weight, since it can lead to growth problems. Instead, we like to see them grow into their weight by making smarter food choices and getting plenty of exercise."
Parents of kids under 2, experts say, shouldn't even think about altering their child's diet. Even if an infant or toddler seems heavier than normal, cutting back on feedings isn't recommended, unless under medical supervision. Since they're going through remendous developmental changes, their growth can be impaired if they don't get enough calories, vitamins, minerals, and fats.
For overweight children ages 2 to 4, however, there are simple dietary changes that parents can make, such as serving pretzels instead of chips, pouring soda only on special occasions, keeping a bowl of orange slices in the refrigerator instead of snack cakes, and substituting low-fat or skim milk for whole. (The AAP stresses that children under 2 should be given whole milk after being weaned from breast milk or formula, because of their higher need for dietary fat.)
In 4-year-old Agusta's case, her grandmother, a professor of food chemistry in Iceland, planted the seed for much-needed change during a family visit. "She wrote down each item we had in the refrigerator and cabinets, listing its calories and fat," says Agusta's father. "It opened our eyes to serving sizes and how we should buy things with less fat."
The family members now eat less at each meal, use low-fat butter, and try to snack on fruit instead of cookies.
When improving a child's eating habits, say experts, the most successful strategies involve the whole family. To teach children to eat more slowly so they're more aware of how much they've consumed, registered dietician Copperman often recommends that parents play a game in which family members are required to put down their forks between each bite at meals; if someone slips up, he or she has to, say, clear the dishes from the table. This exercise also helps kids recognize when they're full.
Even more important, parents should encourage their kids to get active by having them play outside after school whenever possible or signing them up for swimming lessons or another physical activity. But making exercise a family affair is probably the best way to encourage activity. "Ride bikes on the weekend," says Epstein. "Play ball. Go for a family hike."
The 1996 Surgeon General's Report on Physical Activity and Health recommends that children get at least 30 minutes of moderate physical activity almost every day, whether it's at once or spread out over several short sessions. And playtime isn't the only activity that counts -- walking to school or helping to wash the car also qualifies.
Stepping up the EffortIf healthier snacking habits and increased activity don't help to stabilize weight, it's probably time for more serious measures. But rather than cutting back on a child's overall calorie intake, parents should focus on serving more balanced meals. "If you count calories you might say, 'A nonfat cookie has 50 calories while a piece of fruit has 60 or 70 calories,'" says Copperman. "But that doesn't take into account the nutritional content. Plus, a kid might eat three or four cookies, which are mainly sugar, whereas the fruit has fiber that would fill him up."
Parents who are not sure about how to serve more balanced meals should seek the guidance of a nutritionist or pediatrician who specializes in children's weight management. That's just what Yvonne Sam, of New York City, did after she became concerned about her son Raynold's cholesterol reading of 309, which was around double the norm for his age. Raynold went to the pediatric weight management clinic at Schneider Children's Hospital, where he underwent a physical exam; the family met with a nutritionist, who asked the parents to write down everything Raynold ate or drank for three days, then helped Sam figure out simple ways to improve her son's diet.
"I cook the same things but in different ways," she says. She now uses light oils, skim milk, and egg whites.
At first, Raynold wasn't happy with the changes. He refused to eat the boiled ham sandwiches his mom gave him for lunch, complaining that he wanted peanut butter and jelly instead. He got angry when his mother told him that he could only have one cup of juice instead of two. And he cried when she refused to give him a third helping of rice.
But over the next two months, Sam says, "I got him to drink more water and eat yogurt for dessert, not candy." Instead of letting him have three servings of rice, she gradually cut him back to two, and now he's down to one.
It didn't take long to see results. Within six months, Raynold lost 3 pounds and went down a full pant size. His cholesterol has plummeted to 175. And he's not the only one to see results. "I lost 40 pounds!" says his mother.
But Sam's most thrilled about the fact that Raynold, now 6, has become outgoing and self-confident. "His teacher says he's more involved with the other kids, that he's a leader now," Sam proudly reports. And he obviously feels good about himself. "He never used to like to look in the mirror," she says. "Now, he loves it. When he gets dressed in the morning he tells me, 'Ooooh, Mommy! I look nice!'"
As for Agusta, in five months she's dropped 2 pounds. The important thing, say her parents, is that her diet -- and the whole family's -- has improved tremendously.
Another bonus: Agusta has more energy than ever before. She alternates ballet and gymnastics classes for 45 minutes two times a week and swims at least an hour on most days in the housing complex pool. "We used to carry a stroller wherever we went, because she would always complain about how tired she was," says her mother, Sigurn Gisladottir. "But when we visited Universal Studios two weeks ago, she happily walked everywhere."
It's clear Agusta also notices the benefits of her improved diet and increased activity. "Look, Mom," she says proudly as she pats her tummy. "It's getting smaller."