Obesity: Most kids don't choose what's for dinner

Childhood obesity affects 34 per cent of kids and it's on the rise.

Vanessa Hrvatin 6 minute read December 11, 2020

Some experts suggest cooking is somewhat of a lost art, with eating out and quick dinners the new norm. World Obesity Federation

Over the last 30 years, the number of children living with obesity in Canada has nearly tripled, now affecting about 34 per cent of kids. Understanding of this chronic disease has evolved over the last few decades, but there are still many unknowns. The issue is complex from both a biological and lifestyle perspective — kids’ bodies undergo many changes, and most don’t have much autonomy when it comes to deciding what’s for dinner. As rates of childhood obesity continue to rise, there is much to consider — most importantly, what’s changed over the last couple of decades and where we’re headed in terms of tackling this disease.

What’s changed over the last 20 years?

In the early 1980s, Dr. Oded Bar-Or arrived in Hamilton, Ont. with a vision: if kids were physically active and ate nutritious foods, they would do better across the spectrum. Today, this concept is widely accepted in large part thanks to Dr. Bar-Or’s early work, which included establishing the Children’s Exercise and Nutrition Centre to support kids with a variety of health conditions by focusing on what they ate and how they exercised. As time went on, more and more kids living with obesity started showing up at the clinic. When Dr. Katherine Morrison arrived in the early 2000s, the Centre had shifted to become a weight management program, the first of its kind in Canada.

“At the time, I don’t think we recognized many of the challenges of working with families in weight management,” says Morrison, who is now co-director of the Centre for Metabolism, Obesity and Diabetes research at McMaster University. “It was very much an eat-healthy-and- move-more approach, which isn’t a very helpful recommendation when talking about obesity.”

Since then, more pediatric weight management clinics have popped up across the country. In 2005, the first clinic in Western Canada opened its doors in Edmonton and by 2014, Ontario had established a pediatric bariatric network comprised of 11 programs across the province.

Despite the uptick in clinics, the field of pediatric obesity has faced many challenges over the last couple of decades. Morrison says screen time and sleep disturbance in kids has increased dramatically over the past two decades, both of which contribute to weight gain. Others point to cooking as somewhat of a lost art, with eating out and quick dinners the new norm.

Morrison says there have been some positive shifts though, one of which has been a greater recognition of how obesity impacts the health of children.

“At first, everyone was worried about how obesity would impact a kid’s life once they were adults, which was a very adult-centric approach and assumed kids themselves don’t have any health issues related to obesity,” says Morrison. “But we’ve come to realize that this isn’t just about what happens when [kids living with obesity] become adults — we need to think about the health and well-being of these children as children.”

All in the family

For families lucky enough to live near a pediatric weight management clinic, this is where they are often referred. Each clinic runs their program a little differently, but all are comprised of a multi-disciplinary team, typically made up of clinicians, dietitians, exercise specialists, psychologists and social workers. The team will work with kids and their families to address anything that could be impacting their weight, from poor sleep hygiene to mental health issues to eating habits.

The challenge of course, is that it’s a family effort.

“Sometimes families come in and they’re really involved and enthusiastic, but a lot of the time families are at their wits end,” says Dr. Geoff Ball, founding director of the Pediatric Centre for Weight and Health in Edmonton. “It’s a time where they’re frustrated and don’t know what to do and kids are ambivalent about the idea, so a lot of our work is with moms and dads about how to create a healthy environment and support their kids in the best way possible.”

Even getting families into the clinic is a challenge. Research has shown that about 60 per cent of families referred to a weight management program never actually step foot in a clinic. For many, even being referred isn’t an option — take Manitoba, which doesn’t have a single pediatric weight management clinic in the province.

At the end of the day, it’s unethical to teach children to consume food which will probably shorten their lifespan

For a handful of teenagers, bariatric surgery is a last resort. SickKids in Toronto was the first hospital in Canada to start performing this surgery on youth back in 2010 and according to Dr. Jill Hamilton, they now perform about 10 surgeries each year.

“All the surgeries to date have been done on teenagers, we haven’t performed it on preteens,” says Hamilton, a pediatric endocrinologist at SickKids. “The surgery is done after a lot of discussion and thought, and the teens have to already have participated in our medical program and shown some behaviour change.”

While still a relatively new field, recent research looking at kids five years post-surgery found they had a similar weight loss trajectory as adults who underwent surgery. This same study also found that adolescents were more likely than adults to have resolved health issues such as type 2 diabetes and hypertension. Hamilton says these findings suggest that having bariatric surgery earlier in life might prevent health conditions that are likely to pop up down the road once a child reaches adulthood.

Aside from surgery and weight management programs, online apps and programs exist to help families address weight gain at home. Hamilton and her team launched Meant 2 Prevent, a site designed to provide information on nutrition, physical activity, mental health and sleep for children, families and clinicians. Earlier this year B.C. launched Generation Health, a 10-week interactive course for families to learn about healthy eating and physical activity which is now being offered virtually. Along with this, Dr. Tom Warshawski — pediatrician and chair of the Childhood Obesity Foundation — offers the families he sees some simple at-home advice: “Cook whole foods, eat lots of veggies, stay away from processed foods and added sugars, and cook homemade meals as much as possible.”

Where are we headed?

Most experts in the field agree there’s still a long way to go when it comes to better understanding who is at risk of developing obesity as a child, and what the best interventions are.

Dr. Katherine Morrison and her team at McMaster have collected data on more than 1300 children from nine weight management clinics across the country as part of the Canadian Pediatric Weight Management Registry. To date, they’ve found the majority of kids who enter clinics are already living with severe obesity — in other words, families aren’t seeking interventions early on. They’ve also found that up to 90 per cent have health issues associated with obesity, and up to 80 per cent have mental health issues. Morrison is also collaborating with Ball and Hamilton to develop a new set of pediatric obesity guidelines which are set to be published next year.

At a larger scale, Warshawski says the best thing Canada can do to curb the rising rates of childhood obesity is to restrict marketing of unhealthy foods and beverages to children.

“It’s a quick win for the government at a federal level and we’ve seen it done with great success in other countries,” he says. “At the end of the day, it’s unethical to teach children to consume food which will probably shorten their lifespan.”

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