Guest: Dr. Janice Key - Pediatric Adolescent Medicine
Host: Dr. Linda Austin – Psychiatry
Announcer: Welcome to an MUSC Health Podcast.
Dr. Linda Austin: I am Dr. Linda Austin, and I am interviewing Dr. Janice Key, who is professor in pediatrics at MUSC children’s hospital. Dr. Key, I know one of your areas of interest is childhood obesity which, I think, everybody by now knows it is quite an epidemic, how serious is this problem in South Carolina?
Dr. Janice Key: Well, I would like to thank you for letting us come here today because we are really concerned about childhood obesity. South Carolina has about the highest rate of childhood obesity in the country. We among the worst, I believe we are about the 7th worst state in the country for childhood obesity. About, 1/4th, 25% of children in South Carolina are obese; we have more than that who are overweight. A 300% increase over the last 20 years.
Dr. Linda Austin: How do you define obese and how do you define overweight? Are their some technical explanations, Dr. Janice?
Dr. Janice Key: You are right, it is different thing in adults where you can just above the certain weight is obese. In children, everything there is by a age, and so the best way to know if your child is overweight or obese is to ask your pediatrician or family doctor or school nurse to determine if that child’s weight is appropriate for his or her age and height that’s called a body mass index, which is a calculation that parents can do themselves, but have to be interpreted by the child’s weight.
Dr. Linda Austin: What about just looking at your child?
Dr. Janice Key: If you look at your child and they look overweight then they are, but the problem is we have become so accustomed to everyone being overweight that a lot of times our eyes miss the fact that our children or other children are overweight. So, you need major children and calculate their body mass index to be sure even if you don’t think your child is overweight.
Dr. Linda Austin: When you say, we have become so a accustomed to, do you think that may be we have come so far as to say that we have become accepting of it or we don’t take it seriously as an issue or it’s become so much the cultural norm that it’s not as disturbing as may be of what have been a generation ago.
Dr. Janice Key: Well, I think it has become normal and hopefully starting just recently people are beginning to see it as a problem. Until now everybody wanted the fatter baby, that’s what grandmother always said, right ?I want fatten up this baby?. Normal, the healthier you are in some cultures, especially if there is a limited access to food, fatter is healthier, and now in the United States where we have unlimited access to high calorie food, it’s working against us. So you are right, only recently have we started to see it as a problem.
Dr. Linda Austin: Undoubtedly, many parents have struggled with the difficulty upon the one hand wanting to show their child to unlimited love and support, and positive recognition and on the other hand being concerned about their child becoming overweight. Do you have any advice or even specific guidance about the words a parent can use, which must be different at different ages, but to begin to addresses with their children?
Dr. Janice Key: Well, we don’t want to make the child feel guilty about being overweight or obese or feel unloved, we don’t want to do any of those things. The one thing parents can do with young child is just control what’s in the environment. The parent buys the food, the parent chooses which fast food to drive through, so just control what’s in the environment. You don’t have to comment on the child negatively at all. Don’t buy sugar containing drinks to have in the household period and then the child will become less accustomed to eating them.
Dr. Linda Austin: So, in another words if you don’t in the calories through the door, calories can end up on the body.
Dr. Janice Key: That’s true for younger children. Unfortunately, older children have their own money and go to the corner store and buy what they want, but you can start younger children control what comes in from the grocery store and then when they are around looking for something to eat at night or when they hungry watching television, if they are on potato chips in the house if there is carrots then that’s what they will snack on.
Dr. Linda Austin: And parents certainly do get all sorts of messages both indirectly and directly about what is good to eat and what is not good to it.
Dr. Janice Key: Absolutely, what they are eating. You know we do that as parents, we are going to have cut out our own potato chips and coke right, to be a good example and not have it in the house. I have, lots of times, patient’s where they will change what they are offering to the child but not change what the rest of the family is eating. They will buy diet soda for the child who is overweight and everybody else is still drinking sugar containing soda. They won’t let the overweight child eat potato chips and the rest of the family still eating potato chips are doomed to failure because they are just tempting that child to cheat on their diet and also they are sending a bad message to the child.
Dr. Linda Austin: The typical scenario, I would imagine, is overweight parents are more likely to have overweight children but you do, every once in a while, see a family of normal weight people where just one child is overweight, why is that?
Dr. Janice Key: Well, that’s true, but it is much more likely, the more obese members of the family, the more likely of child is to be obese, but every child has different degrees of which they are physically active, the less physically active a child is the more likely they are to be obese. Very rarely medical conditions can cause obesity, endocrine conditions or hypothyroidism, and you should always to have your physician check and be sure that’s not a problem your child, but usually there are some children that need to eat more or less active, you know we are discovering many, many different genes that control appetite and satiety, how quickly you feel full and you are response to feeling full. We don’t really know how that contributes to childhood obesity yet, we will some day, but I am sure there are variations in that.
Dr. Linda Austin: You here individual say, grownups say, I have a fast metabolism or have a slow metabolism? outside of clinical condition like thyroid problems. Is that really true or that is metabolism or is it actually calorie consumption and then levels of activity that they may not even realize.
Dr. Janice Key: That’s right, even though it seems unbelievable to people that are overweight, if you measure basal metabolism that’s how much energy your body uses doing nothing just breathing and your heart beating, is the same for lean people and for overweight people adjusting for size it’s the same; they never can believe it, but it is the same. It’s the amount of activity that you require of your body that makes a difference in the calories that you consume.
Dr. Linda Austin: So, then some people and some children are just innately more fidgety or more likely to jump up than others and that lead to weight changes.
Dr. Janice Key: That’s right, and there is some couch potatoes, they are just sitting still on the couch unfortunately eating while they are watching television, that’s a trigger. You should train your children to not eat away from the dinner table, not eat alone in their room, and not eat when they are watching television.
Dr. Linda Austin: Let’s pause for now and then another Podcast. Let’s talk about some basic tips for parents? Thanks Dr. Key.
Dr. Janice Key: Thank you
Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health connection at (843) 792-1414.