What Happened to Childhood?

It's nothing like I remember. I remember walking to school-- just a few blocks to elementary school and less than 2 kilometres to high school. I remember playing outside all day, making up games with other neighbourhood kids until mom called us in as it got dark. I remember finding pop in the fridge and knowing that meant that mom and dad were having people over.

At the risk of sounding incredibly old, being a kid is entirely different now. Parents drive kids to school even just a few blocks away. Unstructured, unsupervised play time seems to have gone the way of Crystal Pepsi and cassette tapes. It's just... different. And those differences are just the tip of the iceburg.

Child obesity has been in the news a lot lately. Along with the disturbing statistics are the discouraging findings-- dieting and food restriction in childhood and adolescence not only fails to result in weight loss, but actually results in a long term increase in BMI. So what can we do that will make a difference?

There are 5 very specific factors which have been shown to accurately predict a child's risk of obesity. The problem is figuring out how and when to identify these factors. Should we be asking about them at the 18 month well baby visit? Should they be added to our Rourke sheets? If we wait until 3 years, is that still too early? Will it be too late?

Here are the 5 factors:

• Consumption of more than one 6-8oz sweetened beverage per day (coke, Gatorade, fruit juices... anything sweet)
• Media time (including TV, computers, video games... even cell phones qualify)
• Parental presence at dinnertime (one or both parents sitting down with kids to eat)
• Unscheduled active time (time spent being active that does not include formal team sports)
• Fast food consumption more than once a week (regardless of type-- Subway sandwiches vs. chicken fingers vs. Big Macs)

Some of these (such as the fast food) are pretty predictable. Others, such as parental presence at the evening meal, are a little surprising. And no doubt just reading these made a lot of parents out there feel pretty darned defensive. But before I get a flurry of comments defending their fast food eating/juice drinking/absence at mealtimes, I need to remind people that these are not rules-- there is no God of obesity looking down on us with a checklist and cursing children who don't follow them with poor health and excess fat. These are guidelines for how to reduce your child's risk, and a place to start examining old habits if your child is starting to fall into the 'overweight' category.

I don't claim to have all the answers. And maybe I'll be more sympathetic when I have my own children to feed. But right now, I cringe whenever I hear a mom complain that her picky toddler won't eat anything but McDonald's french fries. Why does a 2 year old know what McDonald's french fries taste like? I can't help but feel slightly judgmental (and then immediately guilty for feeling judgemental) when parents bring an obviously overweight child into my office. Unless this child is independently wealthy and buying their own food, the responsibility falls squarely in the parents laps. They control what is available to eat in their house. And, for better or for worse, the parents activity level is the biggest predictor of how active their kids will be.

I don't claim to have all the answers. I'm certainly not immune to concerns over body weight-- it's been at the forefront of my mind for as long as I can remember. I remember being 8 or 9 years old and refusing to wear a purple striped top because I believed it made me look fat. I don't want that for my kids, and I wish I knew how I could ensure that weight won't be a problem for them. I know I can't guarantee it, but I'll do the best I can by not having unhealthy foods in the house, being active as a family, limiting computer/TV/video game time and making sure that Mr. Couz or myself is there to sit down to dinner. And when my patients come in asking me to put their chubby kids on a diet, I'll give them the same advice. I just hope that will be enough.