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How to Manage Juvenile Obesity Epidemic with Physical Activity

Recent decades have seen a dramatic worldwide surge in the prevalence of juvenile obesity. While the causes of this epidemic are not clear, a reduction in the time spent on physical activities and the increase in sedentary pursuits such as TV watching or computer games are likely important factors. Enhanced physical activity is an important component of any program that focuses on weight control. Such a program should include elements that induce appreciable energy expenditure. However, the inclusion of resistance training is efficacious in the enhancement of fat-free mass. Children will not increase their activity "because it is healthy.They must see immediate gratification in becoming more active. This can be achieved by engaging the child in enjoyable activities.

Why Are Obese Children Insufficiently Active?

• Obese children and youth are usually less active than their non-obese peers. There are several reasons for this pattern: Obese children often feel that their body is "ugly;" one outcome is that they may be unwilling to wear a T-shirt or other "revealing" clothing in public. For example, obese boys often perceive the fat pads in their chest to resemble the female breast. This, in itself, may be a reason for their reluctance to join sports activities.
• One of the most common complaints of obese children and youth is that they are ridiculed and teased by others. This occurs mostly at school, but also in the neighborhood and even at home. As a result, they tend not to socialize and remain isolated from their peers.
• Obese children often have obese parents who themselves prefer a sedentary lifestyle. Because children's activity behavior, especially in the first decade of life, is strongly influenced by the lifestyle of their parents, it is likely that obese children of inactive parents will choose not to be active.
• Because of their excessive body weight, obese children are less likely to perform well in activities that include running or jumping. This includes most team games, as well as many track & field events. One outcome is that they tend to excuse themselves from physical education classes.
• A low activity level is likely to induce an excessive increase in body weight. This in itself often causes the child to be even less active and leads to further weight gain. The end result is a vicious cycle of obesity-inactivity-obesity.

Knowing the reason why a given child opts to be sedentary is important in determining how best to help that child become more active. Health professionals and educators should, therefore, include a thorough analysis of the child's habitual activity and the barriers to an active lifestyle that must be overcome by that child.

Benefits of Enhanced Physical Activity

An ideal program for obese children and youth includes nutritional changes, enhanced physical activity, and behavior modification of both the child and the parents. Research has shown that enhanced physical activity, in itself, can yield several dividends. These include:

• Weight control
• Reduction of total body fat and the fat around the abdominal organs (which reduces the risk for coronary heart disease)
• Reduction in high blood pressure
• Decrease in the risk of "adult-type" diabetes
• Increased physical fitness and improved self-esteem .

To accomplish some or all of the above benefits, activity programs must be sustained. Once they are stopped, most of the benefits disappear within several weeks.

Elements of Enhanced Physical Activity Programs

• Activities Must Be Fun. While adults may opt to increase their activity level because "exercise is healthy;' children need other motivators to become and remain active, mostly those that induce immediate gratification. For that reason, an indispensable element of an activity is that it be fun. If children are made to join activities that they do not perceived as enjoyable, it is unlikely that they will sustain them. One must therefore identify those activities a given child enjoys and those the child considers boring or a chore. This selection process may involve a trial-and-error period until favorite activities are identified. Remember that these are likely to change with time and with the season.
• Activities Should Move the Body Over a Substantial Distance. Ideally, activities should include moving the whole body over a substantial distance, in order to "bum" energy. While walking and jogging can achieve this, such activities are considered boring by most children and youth. Favorite alternatives include dancing, basketball, skating and cycling - all of which have a "fun" element.
• Include Resistance Training. The addition of a resistance-training component is beneficial as well. It helps to increase fat-free mass, muscle strength, and, most importantly, the child's self esteem and sense of accomplishment. The advantage of resistance training is that an increase in strength can be perceived within a very short time (1-2 weeks), which is an important motivator.
• Build on the Obese Child's Strong Points. Obese children are usually tall and strong. As a result, they can be successful in activities that require height and strength. Examples are basketball and football, as well as throwing events such as shot-put and discus. Because of their slowness and low agility, they may not excel in such sports, but they will still do better than in activities such as track, soccer or jumping events.
• Use Water-Based Activities. Obese children and youth often prefer water-based to land-based activities. Being in the water provides three advantages for the obese person: 1) Because fat is buoyant (lighter than water), the body weight of obese people is carried by the water, which helps them to keep afloat. In contrast, their large body weight on land is a distinct disadvantage in sports that require speed, agility and stamina. 2) The fat layer under the skin provides excellent thermal insulation and prevents excessive loss of body heat. This gives an advantage to obese individuals when the water is cool (e.g., 22-24 degrees C, or 71.6-75.2 degrees F). Most lean people cannot stay in the water long at these temperatures because of a rapid heat loss. 3) Once a child is in the water, no one can see his or her "ugly body." This decreases the inhibition that some obese children have when they display their figures during land-based activities.

SUGGESTED ADDITIONAL RESOURCES

Bar-Or, 0. and T. Baranowski (1994). Physical activity, adiposity, and obesity among adolescents. Pediatr Exerc. Sci. 6:348-360.

Crespo, C. J., E. Smit, R.P. Troiano, S.J. Bartlett, C.A. Macera, and R.E. Andersen (2001). Television watching, energy intake, and obesity in US children: results from the third National Health and Nutrition Examination Survey, 1988-1994. Arch. Pediatr Adolesc. Med. 155:360-365.

Gutin, B., S. Owens, S. Riggs, M. Ferguson, S. Moorehead, F. Treiber, W. Karp, W. Thompson, J. Allison, M. Litaker, K. Murdison, and N.-A Le (1997). Effect of physical training on cardiovascular health in obese children. In: N.Armstrong, B. Kirby, & J. Welsman (Eds.), Children and Exercise XIX. London: E. & F.N.Spon, pp. 382-389.

Seidell, J. C. (1999). Obesity: a growing problem. Acta Faediatr Suppl. 88:46-50.

Sothem, M. S. (2001). Exercise as a modality in the treatment of childhood obesity. Pediatr Clin. North Am. 48:995-1015.

Tremblay, M.S., and J.D. Willms (2000). Secular trends in the body mass index of Canadian children. Canad. Med. Assoc. J. 163:1429-1433.

Source: www.gssiweb.com, Sports Science Exchange, Volume 16 - 2 (2003)

Adapted by Editorial Staff, November 2006
Last update, July 2008