By Joseph H. Hubber

Obesity and Weight Loss in Children and Adolescents

The following quotation from a 1992 National Institute of Health Conference helps to define the issue of obesity and the problems associated with weight loss in the United States.

A health paradox exists in modern America. On one hand, many people who do not need to 'lose weight are trying to. On the other hand, most who do need to lose weight are not succeeding. The percentage of Americans whose health is jeopardized by too much weight is increasing.

The problem of obesity is becoming an increasingly prevalent nutritional disorder among children and adolescents. Data from four national surveys demonstrate a pronounced increase in the prevalence of pediatric obesity. Depending on the group studied, the prevalence of obesity and superobesity among children and adolescents has increased by between 17 and 306% over the last two decades (American Journal of Diseases of Children, May 1987).

Attempts at weight reduction are also very common among school age children and adolescents. David Wilson of the National Centers for Disease Control and Prevention explained to the U.S. House of Representatives Committee on Small Business in 1990 that approximately 28% of boys and 61 % of girls reported they had dieted to lose weight at some time within the previous year.

Current statistics related to pediatric obesity have gained the attention of the commercial diet industry in recent years. Specifically, promoters of diet programs now advertise weight loss programs tailored to needs of children and adolescents and assert that these programs are safe, easy, and nearly always effective. In addition, past medical literature has supported the premise that commercial weight-reduction programs may be beneficial for older children and teenagers (Pediatrics, December, 1981 and JAMA, April 28, 1993).

Federal Government Intervention

Recently, the Federal Trade Commission (FTC) has been studying advertising practices of commercial diet companies related to patient safety and consumer protection (Consumer Reports, June, 1993). In December of 1993, the FTC gave final approval to consent agreements which settled charges that three commercial diet programs (Physicians' Weight Loss Centers of America, Diet Centers, and Nutri/System) made unsubstantiated weight loss maintenance claims. Cases against Weight Watchers and Jenny Craig are currently in litigation.

Unlike medicine, diet programs do not fall under the scrutiny of the Food and Drug Administration; this body considers weight loss programs essentially mer,u plans (U.S. News and World Report, February 3, 1992). Moreover, the qualifications of program personnel vary widely. U.S. Representative Ron Wyden, Chairman of the Committee on Small Business, notes that: "Frequently, these programs claim to be run by trained personnel when in fact the 'counselors' are little more than glorified salespeople." Often, no medical background is required of personnel. Furthermore, no standardized licensing or certification requirements have been established (Journal of the American Dietetic Association, October, 1991).

In their book entitled Feeding on Dreams: Why America's Diet Industry Doesn't Work (1994), Epstein and Thompson maintain that in the last decade of the twentieth century, the medical and scientific communities' connection between long-term weight loss and exercise has been substantiated. However, the commercial diet programs pay only lip service to this strategy.

Dr. WilJiam Dietz, Director of Clinical Nutrition at the Tufts New England Medical Center, stresses that "commercial weight loss programs are not appropriate for children and adolescents. We need to encourage young people to make permanent changes in their diet and activity pattems--excess time spent viewing television specifically:"

Questions to Physical Educators

Are obese children and adolescents turning to commercial diet programs out of desperation? What schoolbased programs does your LEA offer that address changes in lifestyle, incorporating patterns of food intake and physical activity that are likely to promote lasting weight loss?

One of the national health promotion goals of Healthy People 2000 is to assure effective prevention of obesity in school children and adolescents. One risk reduction objective suggested by this national effort is to significantly increase the proportion of students who participate in daily school physical education. To achieve this objective, is it in the best interest of physical educators to endorse the National Education Commission on Time and Learning report entitled Prisoners of Time? The report documents the need for extending both the length of the school day and school year. Could this strategy enhance greater participation in physical activity and ultimately a change in students' lifestyles?