TUPELO • Forty percent of children in grades K-12 in Mississippi are either overweight or obese.
Yes, you read that right.
Almost half the kids in this state are headed for diabetes, hypertension and heart disease, and that number is actually down.
The American Academy of Pediatrics describes severe obesity among children and adolescents as an “epidemic within an epidemic,” one that portends a dramatically shortened life expectancy for today’s generation compared to their parents.
“A generation ago, two generations ago, a fat child was a sign parents could afford food for their children,” said Dr. Dan Jones, director of Clinical and Population Sciences at the Mississippi Center for Obesity Research. “You didn’t want your children to be thin. That meant you weren’t feeding them enough.”
Today, doctors, researchers, school nurses and dietitians are among those working to reverse that trend and lower the numbers. The key, they say, is getting the message out early.
“Healthy children do not necessarily turn into healthy adults,” said Dr. Nikki Ivancic, a Tupelo pediatrician. “But an unhealthy child will turn into an unhealthy adult. Obese children turn into obese adults.”
According to the Centers for Disease Control and Prevention, Mississippi, at 37.3 percent, has the second highest rate of adult obesity in the nation, preceded by West Virginia at 37.7 percent. Adult obesity in the state has increased dramatically, up from 23.7 percent in 2000 and from 15 percent in 1990. A report from Trust for America’s Health and the Robert Wood Johnson Foundation suggests Mississippi’s obesity rate could reach 66.7 percent by 2030.
“Obesity is a health problem,” Jones said. “For so long in our society, we’ve seen it as a social issue. Obesity forms the roots for diabetes, hypertension, cardiovascular disease. Childhood obesity is the strongest predictor of adult obesity.”
So where do we start?
“If we’re going to really change direction, it’s got to begin with the youngest children,” Jones said. “After puberty, it’s hard to change the direction of body weight. It’s much better to prevent obesity than to try to treat it. Preventing obesity in children is by far our best national strategy.”
Josie Bidwell, an associate professor of preventive medicine at the University of Mississippi Medical Center in Jackson, said children need to act as change agents for the family.
“We can provide information and education to children that will trickle down to the rest of the family as well,” Bidwell said. “Good nutrition for kids is the same as good nutrition for adults.”
In 2017, researchers from the University of Southern Mississippi found the combined prevalence of overweight and obesity for all students in grades K-12 was 40 percent, down from 43.9 percent in 2005.
The Child and Youth Prevalence of Obesity Study, conducted biennially from 2005 through 2017, also showed the obesity prevalence among high school students grades 9-12 increased significantly from 23.5 percent in 2005 to 25.2 percent in 2017, while the obesity prevalence for Mississippi elementary school students in grades K-5 decreased from 25 percent in 2005 to 21 percent in 2017.
So starting early actually seems to be working for Mississippi.
“Our early childhood numbers are improving, but we still have a big problem,” Jones said. “If I had to point to one reason the numbers are down, I’d say it’s because of school-based policies and taking the calories out of vending machines.”
In 2006, the Mississippi Legislature adopted the Mississippi Healthy Students Act, a stair-step program that gave public schools a chance to decrease some of their unhealthier options and increase the healthier ones. Some of the specifics of the act included offering milk choices that have a maximum milk fat of 2 percent or less; limiting fried foods and eliminating fryers in kitchens; incorporating whole grain products into lunches and breakfasts; offering snacks that have 200 calories or less; and providing more fresh fruits and vegetables to students.
“I do know that our students are selecting more servings of fresh veggies and fresh fruits since they are offered daily on our cafeteria menus, many from local sources,” said Lynne Rogers, director of School Nutrition Services for the Tupelo Public School District. “The restrictions on total calories, sodium, and saturated fat are helping to keep healthy choices available to all students who participate in the school meal programs. More manufacturers are catching up and making products that meet the menu regulations and are high quality products that students want to select for their entrée. No frying in most school districts has also made a big impact on student intake of calories.”
But schools can only do so much. The real work has to begin at home with parents.
“The biggest problem with childhood obesity is parents,” Ivancic said. “They’re the ones who buy the groceries. Parents have to be on board. Ten-year-olds don’t do the grocery shopping.”
She said often parents underestimate the size of their children.
“Our idea of what a child is supposed to look like is off,” Ivancic said. “But I do have more patients coming in now who realize obesity is an issue.”
Part of the problem is poor eating habits.
“I tell parents all the time if I could live on chocolate cake, I’d live on chocolate cake,” Ivancic said. “But I know I have to have my broccoli. Kids have learned that if they don’t eat what they want to, then Mom will give them what they want. Parents will prepare a meal and if the kid doesn’t like it, the parent then fixes something the child wants. People say their kids won’t eat it if it’s not good. I say they’ll eat it if they’re hungry.”
Dr. Shane Scott, who is board certified in both internal medicine and pediatrics in New Albany, said when children are born, their palates are clean slates.
“When you give them chicken nuggets and french fries, you’re setting up their tastes early,” he said. “Parents have to set them up early to make healthy choices. Kids eat what their parents eat. If it’s in the house, kids are going to have access to it. We have to change the family dynamics.”
Some will argue that healthy eating is more expensive, but a number of studies have confirmed that fresh produce is more affordable than you might think.
In 2004, the U.S. Department of Agriculture analyzed data from household food purchases made in 1999, including multiple types of fruits and vegetables. The researchers concluded that the average American can purchase four servings of vegetables and three servings of fruits for just 64 cents a day. If this figure were adjusted to today’s costs, the price might be an average of less than a dollar a day.
“Convenience is a big factor,” Bidwell said. “It’s fast and easy to get cheap meals loaded with fat and salt and sugar that taste good. It’s also convenient not to exercise or to play games on line.”
The reasons for childhood obesity are multi-faceted, Scott said.
“There’s the cost of food, the time it takes to make healthy meals, but we also have to take into account screen time,” he said. “Screen time means decreased activity. Early on, you had video games that offered things like dancing. Now, a lot of games are more sedentary. Parents have to take the initiative to set screen time limits. Having parents on board is key to long-term change.”
“Kids have screens all the time now,” Ivancic said. “They have cell phones, TV in the car, computers at school, video games after school, TV after supper.”
She’s a big believer in the American Academy of Pediatrics’ 5-2-1-0 rule.
“Five fruits and veggies every day, two hours or less of screen time, one hour of exercise and zero sugary drinks,” Ivancic said. “Exercise, limiting screen time, eating fruits and vegetables – these are good rules for everyone to follow, even if they don’t have a weight problem. And if there’s just one thing you can do, cut out the sugary drinks. That makes a world of difference.”
And exercise doesn’t mean getting out and running for an hour.
“Do something together as a family,” Ivancic said. “Go for a bike ride, go for a walk in the park, play ball in the front yard.”
While kids need 60 minutes of physical activity every single day, it doesn’t all have to be done at once.
“The beauty of it is play counts as physical activity,” Bidwell said. “Playing on the monkey bars, jumping rope, kicking a soccer ball – that all counts. Find something you can do as a family. Kids copy parents’ choices. Make them see that physical activity is just part of the day, not punishment.”
Rebekah Wilson knows a thing or two about kids and exercise. Wilson is the director at HealthWorks!, a children’s health education center in Tupelo.
“Our whole purpose is to encourage kids of all ages to make healthy life choices,” Wilson said. “We teach in fun ways, but health education is at the center of it all.”
The facility offers classes for toddlers and pre-schoolers, after-school exercise classes for K-5 students, and health and P.E. classes for home-schoolers, as well as family-oriented events and field trips.
“What we love seeing is kids who come here and get excited about healthy habits,” Wilson said. “When we ask them questions, they know the information. They know about the different food groups, they recognize different fruits and vegetables, they know to pick water over sugary drinks. We want the kids to take what they’ve learned back home. We can teach kids all day long and they can get excited about the message, but we need to impact the adults, too.”
Wilson said while the children have an increased knowledge of what good health looks like, implementing that knowledge is the real challenge.
“It’s easy to watch TV or spend time on tablets and phones,” she said. “It’s easy to pick up fast food. To be healthy is an overwhelming task. But a couple of small healthy habits can make a big difference.”