Kids’ Weights Can Be an Issue in Affluent, Working-Class Areas
By Lance Chilton, M.D./
For the Journal
YOUR CHILD'S HEALTH: Q: My husband just took my 6-year-old to her pediatrician for her checkup. The pediatrician said that her BMI was rising. My husband came home with a garbled explanation. Please explain, and tell me what I should do.
A: BMI, or body mass index, is used by many physicians, nutritionists and others to assess a person’s weight for height. The higher the number, the more likely that person is to be overweight compared with his or her peers. The BMI is relatively easy to calculate, requiring only the height and weight and age and or graph of normal values for age.
You haven’t given me some vital information needed to answer your question. Where do you live, and how high is your family’s income? Lacking that information, let me answer the question twice, once for if you have a higher-than-average income and live in a well-off part of Albuquerque, and once for the opposite situation.
1. I’m happy for you that you’re well off and live in a pleasant part of town. Your child may be a little overweight now, but there are lots of things you can do. I would remind you of the four messages from the Kaiser-Permanente program on maintaining optimal weight:
Exercise at least 30-60 minutes per day.
Avoid more than 60 minutes of “screen time” (TV, video games, computer) per day.
Eat at least five helpings of fruit or vegetables per day.
Drink low-fat milk or water, not soda or juice drinks.
Your options for exercise are many. There’s probably a nice, safe park nearby where you and your child can run, throw a Frisbee, jump rope or toss a baseball. Consider joining a pool where your child can swim frequently or a gymnastics or rock-climbing program. Soccer is a good choice for even poorly coordinated young children. If your child has too much screen time, wean her off, suggesting one of the many activities available nearby, including at the Nature Center or the Explora! museum. Children stuck in front of a screen aren’t exercising and often are snacking while they watch.
Changing her diet takes some ingenuity. Well-off neighborhoods usually have many choices of food stores, including some “natural” or “organic” food stores if you wish to use them. Most of the food stores in affluent neighborhoods have plenty of choices of fresh fruit and vegetables — if your child doesn’t like peas, try jicama; if oranges are old hat, try those cute little kumquats.
2. I’m sorry that your family is economically challenged, which makes it hard to move away from your impoverished community.
For exercise, you might try the park, though sometimes in your neighborhood, parks are unsafe. The city pools don’t charge a lot, though I know that any extra expense is hard, and a gym or a bike or soccer uniforms are out of the question. There are parts of Albuquerque where the streets are dangerous and where I would not allow my child to run or walk. It’s probably safe inside, so often your neighbors feel they have to let their children watch TV until they get home from work.
How about changing her diet, then? In many poor communities, grocery stores have moved away, leaving the choices few, and the fresh produce lacking. Forget about unusual fruits and vegetables — they’re just too expensive if they’re available at all.
Who’s to blame that health outcomes, like proper weight or incidence of most forms of cancer, heart disease and stroke, are worse in poor communities? Is it in the genes of those who are poor?
I think not, and a group called Health Equities Workgroup thinks not, believing that race and socio-economic status are very important determinants of health. Perhaps all of us are to blame for allowing healthy choices to not be choices in poor communities, and for restricting access to health care for the poor. “After all, you just go to an emergency room” is not a good answer.
The Health Equity Workgroup’s co-chairwoman, former New Mexico Public Health Division chief Christine Suozzi, says that “We could be the healthiest state in the nation if we adequately funded public health and made preventive health available for all. We need to value people.”
You can get a good start at seeing disparities and possible solutions by viewing “Unnatural Causes,” a four-part series on KNME-TV, Channel 5, starting at 9 a.m. April 20. Even if it means taking time out from your exercise program to watch TV.
Lance Chilton, M.D., is a pediatrician at the Young Children’s Health Center in Albuquerque, associated with the University of New Mexico. He is happy to hear from those with questions at 272-9242 or lancekathy@yahoo.com.
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