Obese Youngsters Learn to Tip the Scales in Their Favor
What’s a kid to do?
Those TV commercials continually tell him he deserves a treat today at his neighborhood fast-food restaurant, and high-calorie, low-nutrient foods--commonly called junk foods--are the most heavily advertised products on Saturday morning children’s TV.
But at the same time, billboard models and movie and TV stars present the slim and trim body as the symbol of attractiveness.
How can kids have both?
Some cannot, and that is the dilemma of the obese adolescent--a population numbering more than 5 million nationwide, according to Dr. David Sternfeld, a Torrance pediatrician who also is medical director of the South Bay’s only weight-loss program geared specifically for youngsters ages 8 to 18, the Body Shop at Torrance Memorial Hospital.
And medical experts say the South Bay is a ripe area for overeating because it has many affluent communities where people have free time, money for rich foods and the psychological stresses that accompany high-achieving people.
“It’s the land of milk and honey,” said Dr. James Tamkin, an internal medicine specialist in Redondo Beach and medical director of the AMI South Bay Hospital eating disorders unit, where the patients usually are adults but also include older teen-agers.
Dr. John Tsau, a Torrance endocrinologist who has treated many overweight teen-agers, said children with weight problems are under pressure. They feel compelled to eat the way their friends do. “They’re out of the mainstream if they don’t keep up with the snacks,” he said, adding that because of genetic factors, some put on weight eating such foods while others do not.
At the same time, these teen-agers are under the gun at home to maintain trim bodies, and Tsau said he has seen youngsters use food as a means of rebellion.
“They eat because parents are really trying so hard to get them to the right weight,” he said. “They are trying not to conform to the ideas and wishes of their parents.”
Medical experts say the causes of adolescent obesity range far beyond America’s preoccupation with food and eating. Some youngsters use food to deal with loneliness and emotional pain, others have poor nutrition and just eat the wrong foods, and others emulate fat parents. Metabolism plays a role, and one of the newer areas of research into obesity is concluding that genetics is a key factor.
“Fat cells in some children are different than in others in terms of number and size,” said Tsau. “That makes it much more difficult for them to manage weight.”
Last year, researchers at the New England Medical Center in Boston put the blame on TV, concluding that hours of sedentary tube watching may cause obesity in some children and adolescents. The conclusion was based on surveys of several thousand youngsters between ages 6 and 17.
Sternfeld said that obesity has signals: “If children are fat at 3 or 4, they remain heavy all their lives. Activity is the greatest thing. If children are not as active as they should be, many times they may be pre-obese.”
And children apparently are becoming preoccupied about weight and looks at earlier and earlier ages. A study at the University of California, San Francisco, reported in February, showed that about 80% of fourth-graders in the Bay City are dieting.
Medical experts say there is no precise way of knowing how many obese adolescents simply eat too much and how many are developing pathological eating disorders--the most prevalent being anorexia nervosa, which is self-starvation resulting from an intense fear of becoming obese, and bulimia, which is characterized by episodic binge eating. Both largely afflict females.
Tsau said that well over 50% of adolescent obesity stems from poor eating habits, which is aggravated by teasing from other youngsters. “This discourages them from exercising because they look awkward” when they do, he said.
Tamkin said he is “appalled” when he takes teen dietary histories: Breakfast consists of cereal “in which the only nutrient is the milk you use,” and lunch is a candy bar and a piece of fruit. “If there’s not a good supper waiting at home, they take the easy way out and have fast foods: a hamburger, fries and a milkshake.”
Tsau said children often eat the most of what they need least: fat and sugar.
“There is a thin line between problem eating and just plain overeating,” said Susan Owen, program director of the eating disorders treatment program at San Pedro Peninsula Hospital. “If the whole person isn’t treated, it can become a lifelong problem. Ninety-five percent of diets don’t work because they do not hit the psychological problems for eating.”
Some Seek Treatment
Some teen-agers do become patients in the eating disorder units at South Bay and San Pedro Peninsula hospitals, according to staff members, but they typically are 16 or older and have developed their problem over a long period of time.
Dr. Crescenzo Pisano, medical director of the San Pedro program, said the anorexic and the binge eater are secretive and often go undetected until they begin doing badly in school. “The disease is so isolating they do it privately,” he said. “The obese person is better off because the family sees it.”
Tamkin said children develop serious eating disorders when they cannot control their world. “There’s school, peer pressure, a lack of love in the family, maybe an alcoholic parent,” he said, and consuming junk food becomes a means of dealing with this pressure.
This is called “stuffing” the emotions in the eating disorders field.
The people who run the Body Shop at Torrance Memorial Hospital make it clear that theirs is not an eating disorders program, and children with significant emotional or physical problems are screened out and referred elsewhere.
For ‘Happy, Healthy’
“This is for happy, healthy youngsters who are overweight,” says program coordinator Jane Diehl. “We try to sell and promote self-esteem and give the youngsters choices for better eating.”
But at the same time, Diehl said there always is a psychological component to being overweight. “Some eat when they are depressed,” she said. “Girls sometimes eat to protect themselves from having to date.”
The 10-week program, which costs $200, combines nutrition with body-toning exercise and dance routines and discussions on grooming and improving personal appearance. Parents also take part and provide support for their children, who sometimes find it hard to tackle a salad when they have ice cream on their minds.
“We stress that young people are responsible for their choices,” Diehl said. “There are reasons we gain weight and we tell them that it’s their responsibility.”
The first Body Shop session, which started in January, had 26 children who lost a combined total of 225 pounds--an average of nine pounds each.
Problem: ‘Just Overeating’
Mark and Ritchie Horowitz of Carson and their children, Joellyn, 11, and 9-year-old Ryan, each lost about 20 pounds on the program. “Our problem was just overeating,” said Mark Horowitz. “We used food as a reward.”
Ritchie Horowitz said she no longer fries foods or bakes and she packs lunches for her children every day. “We’ve become good at peeling and slicing carrots,” Mark Horowitz said.
Several children who had completed the program rattled off the tips they had picked up for better eating: Use smaller plates so it looks as if you’re eating more food than you are; eat slowly; cut out candy; exercise and walk to school instead of riding; ride your bike 15 minutes for each cookie you eat; and wear clothes with vertical stripes to make you look thinner.
But it’s not always easy. “It’s hard to watch my friends eat when I can’t have what they’re having,” said Jennifer Campbell, 13, of Palos Verdes Estates. “But then I have to say, ‘I’m trying to lose weight.’ ”
Teamwork Stressed
Weight-loss experts say that the support of family and friends is vital for the adolescent who is trying to stay off the sweets and junk foods that his friends thrive on.
Sternfeld said that in his private practice he has had little success in keeping youngsters from regaining weight they have lost. “It takes a team,” he said.
Said Mark Horowitz, “The family has to be supportive and root the kids on.”
Ironically, while a desire to be thin is a strong motivator for teen weight control, difficulty in losing weight can put him back on junk food. “Difficulty with weight loss can frustrate to the point where the kid will say, ‘What the hell, I’m fat so I’ll just get fatter,’ ” said Tsau.
For compulsive overeaters who binge after they have been in treatment, pride and perfectionism are roads to destruction, said Virginia Ryan, clinical supervisor at the San Pedro eating disorders unit. “They assume they’re a failure and say they might just as well abuse,” she said.
Overeaters Anonymous
Once they leave eating disorder units, patients maintain their weight loss through Overeaters Anonymous, which is patterned after Alcoholics Anonymous and helps people break their dependency on food and maintain their weight.
Staff members of the eating disorders units say they expect to see more young people as more becomes known about pathological eating.
“Eating disorders are more prevalent than we might think,” Ryan said.
Owen of the San Pedro unit said eating disorders develop in families where there is no communication or love. “Food is used as a stress reducer,” she said. “You have to learn to nurture yourself by other means than food.”
Tamkin said that while the health hazards of obesity--including hypertension, diabetes and cancer--long have been known, it was recognized as a disease only last fall by a panel of the National Institutes of Health. That panel urged that anyone 20% or more above a normal weight make a serious effort to reduce.
“It’s where alcoholism used to be,” he said.
