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July 2019 Obesity has many causes. At its most basic level, it is caused by more energy going in than is being utilized by the body. But the true causes of obesity are often rooted in physical, emotional, and cultural issues that are interrelated and must be addressed together. If children are to achieve a healthy weight, they (and their parents) need to understand how the human body works and be aware of any emotional triggers that may exist. Ten years ago, I started working with pediatric patients and was surprised by how many children and teens were obese. Obesity is measured by body mass index (BMI), which, roughly speaking, is calculated by dividing a person's weight by their height. For children and teens, BMI is age- and sex-specific, and obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex. (To check your child’s BMI, visit www.cdc.gov/healthyweight/bmi/calculator.html.) When children carry excess weight from an early age, they face physical and emotional barriers to good health. They have an increased risk for high blood pressure, high cholesterol and cardiovascular disease. They are also more likely to get diabetes, fatty liver disease, gallstones, and experience heartburn and joint pain. Equally damaging can be the psychological impacts of obesity, which include lower self-esteem, increased incidence of depression and anxiety, and the torment of being judged or even bullied because of the stigma around childhood obesity. At MCHC Health Centers, we have a BMI Clinic for children with a BMI of 35 or higher. The clinic is as busy as can be and includes patients from toddlers to teens. We use a multi-disciplinary approach, which means we consider the patients’ health from many perspectives and include several health professionals from several disciplines. We have an amazing nutritionist, Tess O’Connell, who is completely honest with patients and their families; she lets them know what works and what doesn’t. We also have a whole team of medical providers and behavioral health providers to support patients as they begin the hard work of creating healthier habits, whether they’re in the BMI Clinic or not. For the youngest patients to succeed—to move toward maintaining a healthy weight—most of the work must be done by the parents. As children get older, it becomes a team effort. Here are the basics of what we teach and how we help people. Move! If I could only give one piece of advice, it would be to make sure kids move. Kids should spend no more than an hour or two a day of sedentary screen time. Go to the park. Have kids run in the sprinklers, ride their bikes, play tag, or do a scavenger hunt outdoors. If you can’t think of anything, Google “healthy outdoor activities for kids” and dozens of suggestions will pop up. Eat Three Meals and Two Snacks a Day Another key success factor is eating well. It may seem counterintuitive, but kids trying to lose weight should not skip meals. The body goes into crisis mode and starts converting food to fat because. Instead, kids should eat well-balanced meals with about half vegetables, and smaller portions of protein, whole grains, and fruit. Skip the refined sugar and processed foods altogether. Recognize Other Issues May Be Influencing Behavior Finally, oftentimes weight gain isn’t just about food and exercise. There can be psychological reasons for kids to eat too much. Many of my patients have high Adverse Childhood Experience scores and they form unhealthy relationships with food to cope with the abuse, neglect or household dysfunction they’ve had to live with. As hard as it is for parents to say no to their children, we must all remember that children cannot create their own limits. Their brains are still developing, so it is up to parents to help their children develop healthy habits. At MCHC Health Centers, we educate and support parents, so they can educate and support their children. Cindi Mockel is a family nurse practitioner at MCHC Health Centers—a local, non-profit, federally qualified health center offering medical, dental and behavioral health care to people in Lake and Mendocino Counties.