Imagine weighing much more than any of your friends - maybe twice or three times as much. You're the last one picked for any sports team. It's impossible to find nice clothes to wear, because everything you like is too small. People stare at you wherever you go: at the mall, on the street - and especially in the school cafeteria when you're eating lunch. Worst of all, other kids tease you and leave you out. The psychological and emotional pain of childhood obesity is immediate. Overweight children are more likely to be shut out socially than youngsters with other physical challenges, according to recent studies. And the long-term effects of obesity are potentially even more harmful. The overweight child runs a higher chance of growing up to be an overweight adult - and subsequently faces a greater risk for diabetes, heart disease, cancer, arthritis, and other life-threatening diseases. "Childhood obesity has been on the rise since 1964, and right now, it's an epidemic," says Richard Strauss, MD, director of the Pediatric Weight Control Program at UMDNJ-Robert Wood Johnson Medical School (RWJMS). "One in five American children is overweight." What's responsible for this increase? While genetics plays a role, the obesity epidemic can't be blamed on genetics alone. Too Much Nintendo, Too Many Calories Many experts, including Strauss, point a finger at lifestyle and social issues. "Kids don't get enough exercise. They're too sedentary," says Strauss. ÒInstead of playing outside, they're in the house watching TV, using the computer, or playing video games." With both parents working, safety is also a concern. More kids stay indoors after school because their parents don't want them playing outside unsupervised. Today's kids also consume far too many calories from high-fat snacks, soda, fast food and takeout. "Homemade meals are becoming a thing of the past," says Daria Rozdilsky, RD, CDE, a pediatric nutritionist with the program. "Not only are families relying more on fast food, but everything they order is 'supersized.' "Strauss, a pediatric gastroenterologist, treats a wide range of weight problems, from "chunkiness," or moderate overweight, to serious obesity. (For definitions of overweight and obesity, see box below.) The multi-disciplinary program, which includes medical management, nutrition guidance, and behavioral counseling, utilizes a team approach. In addition to Strauss, there are two pediatric nutritionists and a psychologist on staff. Approximately 200 participants ranging in age from 7 to 18 are enrolled in the program, and two or three new patients are added every week. The cost is flexible for patients whose insurance does not cover weight control programs. Learning Healthier Habits Patients first meet with a pediatric nutritionist for a comprehensive dietary evaluation. They are asked about all the foods they eat in a typical day, including fast and takeout food, snacks, and sweetened beverages. After reviewing eating and exercise habits, the nutritionist suggests changes that will promote healthy eating and less fat and fewer calories overall, and to exercise and be more active. continued

What Is Obesity?

BMI, or body mass index, is currently the most accepted method for screening for obesity. It is calculated by dividing a child's weight in kilograms by his or her height in meters squared. Taking into account variations for age and gender, children with BMIs above the 85th percentile are overweight, and children with BMIs above the 95th percentile are obese. Overweight can be defined as being heavier than recommended on standard weight charts. A child who is 25 percent above the ideal body weight for his height and age is considered obese. Someone who is 50 percent over ideal body weight is considered moderately obese, and one who is 80 to 100 percent over ideal weight is severely obese. Says Strauss: "Children who are severely obese are unlikely to lose weight without professional help."