Wen Dr. Melynda Noble started practicing medicine, seeing children with coronary artery disease was almost unheard of, but today that's not the case.
The predominant cause: the ever growing problem of childhood obesity.
In December, the American Heart Association reported that 10 percent of U.S. children ages 2 to 5 are overweight. That is up from 7 percent in 1994.
Nearly 4 million children between the ages of 6 and 11 are overweight, and 5.3 million young people ages 12 to 19 are overweight or obese, according to the report.
"We definitely have a ton of it in this area, and we have all the risk factors," said Noble, a pediatrician with Greenwood Leflore Hospital Children's Clinic on Strong Avenue.
"It's national. Every meeting we go to now, there's always information on childhood obesity and the longterm effects," she said.
"Used to, when we would think of coronary artery disease, we would say, 'that's in your 40s or 50s.'"
But today, she said, doctors are seeing it in teenagers.
Hypertension and diabetes also are more prevalent in children today due to obesity.
Noble said when doctors see nine-month-old babies who are overweight, they don't get excited about it, unless the mom and dad are obese.
But when they see an older child who is overweight, they have to deal with it differently than they would an adult, she said.
It's a delicate matter, Noble said. "You don't want to lose weight and slow everything down," she said, because children are still developing.
According to an article in "Contemporary Pediatrics" by Drs. Juliet Collins, Susan L. Johnson and Nancy F. Krebs, treatment of overweight toddlers younger than 2 is often not recommended.
"This is partly because of the recognized importance of growth, including brain growth, during infancy and early childhood, and thus the care that is essential to avoid overly restrictive dieting in this vulnerable age group. The fact that excessive weight is less likely to persist in young children may also contribute to a reluctance to
intervene," the article said.
According to KidSource, "As with adult-onset obesity, childhood obesity has multiple causes centering around an imbalance between energy in (calories obtained from food) and energy out (calories expended in the basal metabolic rate and physical activity). Childhood obesity most likely results from an interaction of nutritional, psychological, familial and physiological factors."
Obesity treatment programs for children and adolescents rarely have weight loss as a goal, according to KidSource. "Rather, the aim is to slow or halt weight gain so the child will grow into his or her body weight over a period of months to years."
Treatment can include physical activity, diet management and behavior modification.
Nutrition programs in the schools can help with controlling childhood obesity, Noble said, but it may be 10 years down the road before we see the results.
"The majority of children eat breakfast, snack and lunch at school. Controlling that diet would help a lot," she said.
But the parents still must be educated.
Noble and other doctors at the Children's Clinic have a packet they give to parents that has the Food Guide Pyramid for Young Children. The packet includes a sheet with pyramid basics, a food plan for young children and a plan for variety, which includes one day's sample meals and snacks. There's also a suggested snack list from the Food Guide Pyramid, healthy eating tips, a guide to child-size servings and a sheet that tells how children can help in the kitchen.
While some families know what's best to feed their children, some of them just can't afford it. Eating the right kinds of food can be expensive, Noble said. Higher calorie foods are cheaper.
Another factor is that most families don't sit down together and eat a meal these days.
"If you look at the European nations, when they sit down for a meal, it's something they're enjoying," Noble said.
"Here, it's the fastest thing you can do to get that meal done so you can eat and do something else.
"If you sit down for a meal and have a conversation, you're going to eat much less than if you're sitting there by yourself just eating in front of the TV."
Noble said she sees parents who come to the clinic and tell her their children just eat all the time.
She recommends that every time a child eats, he be sitting at the table.
"If he's sitting down at the kitchen table, then he's going to have to choose if he wants to watch that on TV or sit down at the kitchen table and eat," she said.
"If adults would do that, you'll notice that that you're not going to eat as much if you can't eat in that living room or that bedroom.
"But that's a lifestyle change that everybody's accepted," Noble said.
"When we sat down to eat our meals, the TV was turned off. We would sit and talk and eat. That's a rarity now," she said.
Getting the tray and going to the living room in front of a television is also detrimental to the family unit, Noble said.
"I thinks it's detrimental to the family unit because your kid is not going to tell you what they did at school today or what their friends did at school today while they're watching TV."
Another lifestyle change that affects childhood obesity is the lack of physical activity.
Their lifestyle is more sedentary than in the past, she said. Now, children want video games, which keep them in front of the television.
Noble said when she was a child, kids got jump ropes and hula hoops. They played outdoors more.
Today, children watch more television.
"Used to, when you watched cartoons, you had to wait until Saturday morning," Noble said. "Now you can watch them 24 hours a day."
Physical education needs to be back in school, she said.
"We can't leave it up to the parents when the parents are working long hours and when the parents don't exercise themselves," Noble said.
Noble said she would love to have an obesity clinic for children in Greenwood.
The problem is lack of time. It takes doctors away from the clinic, she said.
"It's a real time-consuming process. You have to sit down and you really have to get into the lifestyle of the child and the whole family," Noble said.
An obesity clinic would also have to have an exercise specialist to deal with the children and teach them what they need to do, as well as their parents.
But the most important thing a doctor would have to do is find out why that child is obese.
"It may just be stress. It may be that it's their way to comfort them. If you don't touch on that and don't deal with that, then changing everything else is not going to help because you haven't dealt with the real issue. And that's much more difficult than changing a diet," she said.
In Greenwood, Noble said, there are several different populations.
"You have the population where it's OK to be overweight. Everybody in the family is overweight, and it's OK. It's not a problem. I don't think it's a psychological burden on those children because it's acceptable," she said.
Then there is the population of teenagers who may be thin, but don't like their bodies because they don't look like a Glamour magazine model, Noble said.
"It's a weight issue for them, although they may not be obese. They're worried about it, and they're stressed over it," she said.
These issues lead to problems with anorexia and bulimia, Noble said.
It's a self-esteem problem. "To them in their minds, their self-esteem is so messed up, they feel like they're several hundred pounds overweight."
Some overweight teens are even taking drastic measures to rid themselves of the weight, such as gastric bypass and other surgical procedures.
"There are some areas that are taking young teenagers and doing that type surgery on them," she said.
"Is that the right thing to do? No. I don't think so," Noble said.
When they have surgery, Noble said, they are still going to have to exercise, and they still have to eat right.
"If you don't do those things, you're not going to be healthy," she said.
"You can be healthy and be 50 pounds overweight, but you can't be healthy and never exercise and not eat right," Noble said.
Health problems are a gradual thing, she said.
"If you see somebody who's 40 or 50 who has heart problems, well that didn't just occur in the last 10 years," she said.
It occurs from years of living an unhealthy lifestyle.
Everything works better when you start taking care of yourself as a teen, she said.
Noble has one big pet peeve when it comes to dealing with obese children. "You can't punish a child for his weight," she said.
"You can't drive through a fast food and everybody get chicken nuggets and you get a salad," Noble said.
"Everybody in the household should be eating nutritiously," she said.
But that's not the case. "That's where the child gets low self-esteem. That's the reason it becomes worse."
Noble said the problem is not as bad in boys as it is in girls.
"I think the self-esteem issue is much worse in girls. In boys, that doesn't occur until they're very, very overweight so they can't function well. If you look at football players, some of those players want to be real stocky and big. But when they're that way, they need to be healthy," she said.
"Certainly the focus needs to be on the children who are overweight, but our focus should be on making all of our children healthy and giving them the proper food and exercise," Noble said.
