Cub
Chat Winter 2004
Your Child’s Weight........2
Health Risks.........3
Healthy Eating Habits........6
Volume 10, Number 4
Weighty Problems ■
“Teens need to pay attention to the calories they drink, the amount of food that they eat and their activity levels. Making small changes in each of these areas can significantly improve their weight and prevent future weight gains,” says Ronald Williams, M.D., director of the Pediatric Multidisciplinary Weight Loss Program at Penn State Children’s Hospital.
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U.S. teens have higher obesity rates than 13- to 15-year-olds in 14 other industrialized nations, according to a study in the Archives of Pediatrics and Adolescent Medicine.
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A study tracked 51 Canadian patients who had been diagnosed with type 2 diabetes before age 17. By the age of 30, seven had died, three were on dialysis, one was blind, and one had lost a toe to amputation.
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More than 60 percent of young people eat too much fat, the U.S. surgeon general says. Less than 20 percent eat the recommended five or more daily servings of fruits and vegetables.
S O L U T I O N S
Tip the Scales in Your Child’s Favor Experts call for action as America’s kids bulk up, putting their health at risk
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ure, the kids are carrying a few extra pounds — OK, maybe more than a few — but how big a deal could that be? It could be today’s greatest threat to public health. “We may see the first generation that will be less healthy and have a shorter life expectancy than their parents,” U.S. Surgeon General Richard H. Carmona, M.D., recently told a Senate committee. Obesity is poised to pass tobacco as America’s leading preventable killer, and it’s a growing epidemic among children. Hospital weight clinics are treating preteens and teens who weigh as much as 400 pounds. Over the past 20 years, the proportion of overweight children doubled among 6- to 11-year-olds and tripled among adolescents 12 to 19. One in seven kids — more than 9 million children — are overweight, says the Centers for Disease Control and Prevention (CDC).
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Their younger siblings aren’t far behind. Ten percent of 2- to 5-year-olds weigh too much. “We called the SARS outbreak an epidemic, and it affected 500 people,” says William Dietz, M.D., director of the CDC’s Division of Nutrition and Physical Activity. “This affects millions of children and adults, more people than HIV–AIDS does.” Excess childhood weight is placing “an unprecedented burden” on children’s health, the American Academy of Pediatrics says. It’s triggering a host of dangerous health problems once seen only in adults. About 10 years ago, for instance, doctors began noticing that overweight children were developing type 2 diabetes — once called adult-onset diabetes — at ages earlier than ever before. Those children will also develop diabetes’ serious and even life-threatening complications at much earlier ages. continued on page 2
C H I L D H O O D
W E I G H T
C R I S I S
CALL FOR ACTION Tip the Scales, continued from page 1
Percentage of Overweight Kids 16 Children 6–11 years old 14 Children 12–19 years old 12 10 8 6
Source: CDC
4 2 0 1963–1970
1971–1974
1976–1980
Many overweight parents don’t feel anything’s wrong when their children become heavy. Other parents worry more about different things. In a recent Ohio survey, for instance, parents listed sexual activity, alcohol consumption and cigarette smoking ahead of weight problems when asked about their top health-related concerns for their children. And still other parents don’t know how to solve the problem. “It is a lot easier to not put on the weight than it is to lose it,” says Ronald Williams, M.D., director
1988–1994
1999–2002
of the Pediatric Multidisciplinary Weight Loss Program at Penn State Children’s Hospital. “Paying attention to the weight problems at a younger age will make the problem easier to correct.” Dr. Williams and his team combine smaller portion sizes and lower-calorie liquids with an easy and fun exercise program to achieve the desired weight goals based on the patient’s medical needs. In Mississippi, the fattest state, doctors see fatalism among the young — the sense that, since kids’ parents and grandparents are overweight and have
Does Your Child Weigh Too Much?
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ow can you tell if your child is overweight? “Parents have to look for it, consider it, to see it,” says Janet Silverstein, M.D., who chairs the American Academy of Pediatrics (AAP) executive committee on endocrinology. “If your children seem to be growing too fast, growing
out of their clothes very fast, especially before puberty, you should check this out with your pediatrician.” The doctor can help you learn whether your son or daughter is overweight. The AAP recommends doctors check kids’ progress at least once a year using growth charts and a body mass index (BMI) calculator from
To assess your child’s weight, go online to www.staywellsolutioncenters.com/assessment.html. 2
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Being overweight isn’t a phase most kids outgrow, either. Overweight adolescents have a 70 percent chance of becoming overweight adults. “The good news is that there is still time to reverse this dangerous trend in our children’s lives,” Dr. Carmona says. But to do that, we need to understand why so many children weigh too much. Genes play a role for some children, but that’s not new. The world kids live in is new in many ways, though. Among the factors: ■ More sedentary lifestyles focused on television and video games ■ Less physical education in schools ■ Eating more meals outside the home, especially fast food ■ Larger portion sizes ■ Too much fat and sugar “More than 40 percent of a family’s food budget is spent on food consumed outside of the home,” Dr. Dietz says. “Soft drinks and 10 percent juice drinks account for more than 10 percent of adolescents’ caloric intake. Food is everywhere. Meanwhile, less than a third of children who live within a mile of their schools walk there.” The average child spends 51⁄2 hours a day using TV, video games, computers and the Internet, the Kaiser Family Foundation says. Sometimes, kids learn unhealthy behavior from us.
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Diabetes Tops the List of Obesity’s Health Risks FAST FACT Roughly one out of every
four or five African-American and Mexican-American children is overweight, the CDC says, compared with about one out of eight Caucasian children. Genetics and socioeconomic factors may play a part.
chronic weight-related conditions, they’re likewise cursed. Nonsense, says Scott Nelson, M.D., a family physician and lifelong resident of Cleveland, Miss. “We need to have a concerted effort to change not only the culture but the perception that obesity is an unstoppable disease. It is preventable. There are things you can do. And it’s a lot easier to do it when you’re a child than someone much older. It’s important to form good habits early.” ❖
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hildren who weigh too much face a broad array of health problems, with type 2 diabetes leading the list. Closely linked to obesity, type 2 diabetes was once so rare among children that it was called adult onset diabetes. But University of Florida doctors, like colleagues nationwide, are seeing “more 12- and 13-year-olds with type 2 diabetes than you can imagine,” says Janet Silverstein, M.D., chief of the university’s division of pediatric endocrinology and chairman of the American Academy of Pediatrics executive committee on endocrinology. Doctors estimate 70 percent of overweight kids will grow up to be overweight adults. Once they’ve been too heavy for too many years, experts say, they’re at risk for diseases that doctors usually see in people in their 60s, 70s and 80s. “We’ll be treating them when they’re in their mid-30s,” says Francine R. Kaufman, M.D., past president of the American Diabetes Association. “Their diabetes will lead to so many problems.” The average age of kids being treated in obesity clinics is about 12. “When these kids grow up and into their most productive years, many of them will be on disability from their diabetes and the many diseases that accompany diabetes,” says obesity researcher Richard L. Atkinson, M.D., president of the American Obesity Association.
the Centers for Disease Control and Prevention (CDC). The BMI, which measures the relationship between a person’s weight and height, applies differently for children because their body fatness changes as they grow, and differs for boys and girls. The CDC offers growth charts for boys and girls ages 2–20. To learn more or find the calculators and growth charts, visit these web sites: ■
www.cdc.gov/growthcharts
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www.cdc.gov/nccdphp/dnpa/ growthcharts/bmi_tools.htm 3
But diabetes is just one of many health problems tied to obesity. “We had an 18-year-old girl with a stroke,” says Dr. Silverstein, whose Florida program is swamped with children. “It’s like this across the country.”
Childhood Ailments Linked With Obesity ■
Diabetes
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High cholesterol and other blood fats
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High blood pressure
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Gallbladder disease
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Polycystic ovaries
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Kidney trouble
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Vision disturbances
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Orthopedic difficulties
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Sleep apnea
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Psychological problems
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Social problems
Obese kids also “have the quality of life, in many cases, of a chemotherapy patient,” she adds. “This is a huge public health problem, and it’s going to get worse,” says Dr. Silverstein. “The trend is still going up.” ❖
SUCCESS STORY
If Your Children Need Treatment
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or overweight children, the most successful treatment combines healthy lifestyle changes — improved diet and exercise — with a focus on changing such behaviors as eating while watching TV. Children also need psychological support to deal with the lack of self-esteem and isolation faced by overweight kids. What about drugs or surgery? Most doctors consider them last resorts for severely overweight adolescents with other serious risk factors. If you’re worried about your child’s weight, talk with your doctor. Depending on your child’s weight and age, the goal might be simply to stabilize your child’s weight so that, as he or she gets taller, your child “grows into” a more appropriate weight. Or, the goal might be to gradually lose and keep off excess pounds. What if your doctor suggests a treatment program? “Look for a program that involves both your child and you,” advises Ellen Rome, M.D., Ph.D., director of the Cleveland Clinic’s HealthyLifestyles Program. “Especially with younger children, you’re the one who’s buying and preparing the food.” The Cleveland Clinic says a child weight-control program should also: ■ Employ a variety of health professionals. The best programs may include registered dietitians, exercise physiologists, pediatricians, family physicians, psychiatrists and psychologists. ■ Evaluate your child’s medical status. A doctor should review your child’s weight, growth and health before enrollment. During enrollment,
a health professional should monitor your child’s weight, height, growth and health. ■ Fit the age and capabilities of your child. Programs for 4-year-olds differ from those for 12-year-olds. They place differing degrees of responsibility on the child and on the parents. ■ Focus on behavioral changes. ■ Teach your child to select a variety of foods in the right portions.
Bright Futures, Georgetown University: Age-appropriate advice and activity books www.brightfutures.org American Obesity Association: Statistics, prevention and treatment tips www.obesity.org/subs/childhood
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wo years ago, Kyle Williams was a 16-year-old who stood 5 feet, 5 1/2 inches tall and weighed nearly 300 pounds. “People picked on me so much with fat jokes; I became a quiet type,” he says. After slimming down from a size 50 to a 36-inch waist, the 18-year-old weighs 192 pounds. Heavy since age 6, Kyle had spent most of his time at home, watching TV, playing video games and eating. Then he decided to do something about it. “I was disappointed in how I looked,” he explains. “I knew I couldn’t make friends because I wasn’t attractive.” So Kyle started frequenting the Christian Street YMCA in South
KYLE WILLIAMS’ ADVICE TO OTHER OVERWEIGHT YOUTHS: “If kids pick on you constantly, turn that memory to your advantage. If you try hard and work your best at it, you can do anything.” ■
Encourage daily activity and limit
sedentary activity like watching TV. Include a maintenance program to reinforce new behaviors and deal with issues that led to the weight problem in the first place. At the Pediatric Multidisciplinary Weight Loss Program at Penn State Children’s Hospital, Ronald Williams, M.D., and his team use these strategies to achieve the desired weight goals based on the patient’s medical needs. ❖ ■
TO LEARN MORE
U.S. Surgeon General: Causes and solutions for the obesity crisis www.surgeongeneral.gov/topics/obesity
Teen Lost 100
Centers for Disease Control and Prevention: Advice on nutrition and physical activity www.cdc.gov/nccdphp/dnpa U.S. Department of Health and Human Services: Small steps to improve diet and fitness www.smallstep.gov
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Pounds and Gained Self-Esteem Philadelphia, a half-mile from his house. Under the tutelage of a Y trainer, he started burning calories on cardiovascular equipment, such as treadmills and stair climbers. Several months later he started lifting weights, too. Working out five or six days a week is hard, he concedes. “But if I got lazy and stopped, I knew I’d have to start all over again, and I kept picturing myself and how thin I would be in two years.” When cousins began noticing his weight loss several months later, “It motivated me to continue working my hardest to lose as much weight and stay as healthy as I could.”
Except on rare occasions, oncefavorite foods such as pizza and Philadelphia cheesesteaks also have become history — likewise chips and candy.
Fantastic job! Remember: “Slow and steady wins the race!” — Ronald Williams, M.D., director of the Pediatric Multidisciplinary Weight Loss Program at Penn State Children’s Hospital Kyle’s mother, who bought him his Y membership, stopped buying such foods so he wouldn’t be tempted. Fruit — bananas, apples, plums, peaches — became his snack food. And instead of greasy takeout food, Kyle and his mom now prefer homecooked meals such as skinless chicken and vegetables. ❖
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FAST FACT Annual costs for treating
obesity-related diseases in 6- to 17-year-olds more than tripled from 1979 to 1999, the federal government says. The price tag rose from $35 million to $127 million.
School- and Community-Based Programs Target Kids’ Lifestyles
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any groups help schools and communities set up programs that can get children to eat right and stay active. Here’s a list of examples you might want to discuss with officials in your own area:
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with academics for kindergarten through grade five. There’s a pre-K program, too — www.take10.net.
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School Health Index: Helps schools assess and improve their physical activity, healthy eating and anti-tobacco policies and programs — http://apps.nccd.cdc.gov/shi.
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Smart Stepping: Helps schools, communities and
businesses create a variety of walking and wellness programs — www.creativewalking.com.
KidsWalk-to-School: Encourages children to walk to
school in groups, and organizes adults to go with them — www.cdc.gov/nccdphp/dnpa/kidswalk/pedsafety.htm. ■
Team Nutrition: Helps schools serve meals that meet dietary guidelines and motivate students in all grades to make healthy eating choices — www.fns.usda.gov/tn.
Hearts ’N Parks: Seeks to help park and recreation agencies
encourage heart-healthy lifestyles — www.nhlbi.nih.gov/ health/prof/heart/obesity/hrt_n_pk/index.htm. ■
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Generation Fit: Sets up student community service pro-
jects that promote more physical activity and healthier eating — American Cancer Society, 800-ACS-2345. ■
Take 10!®: Blends 10-minute bouts of physical activity
These examples come from the International Life Sciences Institute’s Center for Health Promotion. For a complete list, visit www.ilsi.org; click on the “Center for Health Promotion,” access “Publications” and look for the Physical Activity and Nutrition Programs List. ❖
New Moves: Encourages high school girls to place less emphasis on our thin-oriented society while embracing healthy eating and physical fitness — University of Minnesota, 612-624-1818.
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HEALTHY HABITS
Make Healthy Eating a Habit
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hen Jodie Shield’s three children order fast food, they know the rules: They can eat fries only once a month, and “supersize” is never an option. The earlier you teach children such sound habits, the more likely they are to maintain a healthy weight. But helping a child learn the right skills takes patience and repetition. “Parents need to be vigilant,” says Ms. Shield,
a Chicago-area dietitian and coauthor of The American Dietetic Association Guide to Healthy Eating for Kids. Well-meaning parents often fear their children are eating too little rather than too much. Overfeeding starts as early as the toddler years. For toddlers, serve a tablespoon of vegetables per meal for each year of age. Pennsylvania State University professor Leann Birch, Ph.D., says that may help head off future struggles
to school. Tangerines, raisins and granola mix are healthy, enjoyable examples.
Nine Easy Steps 1. Add volume to highfat foods so kids feel satisfied without getting too many calories. For example, top a frozen pizza with mushrooms or broccoli.
4. Don’t let children leave home without breakfast. At least serve a piece of fruit, fat-free milk and a whole-grain cereal.
2. Have a plan for eating out. Choose fast-food restaurants that offer salads, and go for low-fat dressing.
5. Take children grocery shopping and let them choose a new fruit or vegetable.
3. Let children choose lunch foods to take
6. Stock the refrigerator with fruits and
Why It Pays to Be a Family of Losers
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hildhood weight control is a family affair. If both parents are lean, a child has a 9 percent chance of becoming obese, the National Institute of Health Care Management says. If both parents are obese, the child has a 60 to 80 percent chance of becoming obese. Involving the whole family lifts a psychological burden off your child. “Then eating better foods isn’t a
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FAST FACT
Physical education in schools has declined sharply. Most high school students only take a year of physical education between 9th and 12th grades.
punishment, but a new way of life,” says Ronald Williams, M.D., director of the Pediatric Multidisciplinary Weight Loss Program at Penn State Children’s Hospital. It’s vital to balance the energy, or calories, that you take in and the calories that you burn. “The body is like a bank,” Dr. Williams says. “You make deposits when you eat and withdrawals when you move.” To help your child succeed: ■ Be a role model. “If you set a good example, they will follow,” says New York internist Erika Schwartz, M.D., author of The Teen Weight Loss Solution. “If you’re not doing it for yourself, do it for your children.” ■ Set firm rules. Learn how to say “no” to your kids and how to set and enforce boundaries. ■ Set specific, reachable goals. 6
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Limit TV time, for instance, or request a certain level of physical activity in a given period. Praise and reward children. Compliment them for eating healthier snacks, or celebrate milestones with a CD. But never use food as a reward or withhold it as punishment. Expect slips. “If a kid lapses once a week by eating a slice of pizza or an ice cream cone, that’s fine,” says child development specialist T. Kristian von Almen, Ph.D., coauthor of Trim Kids. But three times a week is a relapse — and you and your child need to talk. ❖
over getting your child to eat vegetables. Snacks should be healthful, just like meals. Make produce a key element. Vary the selection of fruits and vegetables to introduce children to new foods. Between ages 2 and 6, children fear new foods, and it may take several tries. But if you don’t make the effort, Ms. Shield warns, your kids may never develop a taste for healthful foods. ❖
vegetables, such as berries and low-fat fruit yogurt for making smoothies. 7. Play with food. Vegetable “faces” made from carrots may get a child’s attention.
9. Urge kids to trade soft drinks for water.
How to Fit In Fitness
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o get your kids moving, find physical activities they can enjoy at their own pace — and become active with them. “Physically active parents equal physically active kids,” says Melinda S. Sothern, Ph.D., director of Louisiana State University’s Prevention of Childhood Obesity Laboratory. It doesn’t have to be “exercise.” Dr. Sothern, coauthor of Trim Kids, suggests an “imagination station” inside, with space to dance and play with hula hoops and balloons. Outside, fill a tub with toys, Frisbees and balls. Here are some more tips from Dr. Sothern and other experts: ■ Talk with your doctor before your child starts a major physical activity, especially if he or she weighs too much or has other health problems. ■ Cut the time you and your family watch TV or play video games. ■ Encourage unstructured physical activity, especially for younger kids. “Have them play tag, hide-andseek, shoot hoops, explore a playground or nature park, bicycle, scooter, fly kites, walk your dog, have a game of catch or jump rope,” Dr. Sothern says. ■ Bar homework, TV, video games and the Internet for 30 to 60 minutes 7
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after kids get home from school. Urge them to play outside instead. Start slowly and easily. As your children get fitter, they can do more and succeed at games and sports. Do things you enjoy together. Encourage your school to provide regular physical education, recess and extracurricular activities. Encourage after-school programs to provide physical play. Consider signing up your child for sports and recreation programs — at a level your child can enjoy. Help create a community environment that makes it easy and safe for your children to walk, ride bikes and use close-to-home facilities for physical activity. Find safe havens if you live in an urban area and worry about children playing outside. Among the options: YMCAs, Boys Clubs, Girls Clubs and the Scouts. ❖
VERB™ encourages kids ages 9–13 to be active. Sites target children (www.verbnow.com) and parents (www.verbparents.com)
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8. Don’t ban popular snacks like chips; kids may sneak them. Just buy small amounts.
NACHRI NOTES
Children’s Hospitals Lead the Fight
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ou can’t read a magazine or watch television without hearing about America’s struggle to lose weight. Addressing obesity is the first step in helping our children grow up healthy. But what is critically needed to win this battle is a greater commitment to research that targets the unique needs of kids. A survey by the National Association of Children’s Hospitals and Related Institutions (NACHRI) found that almost half of pediatric researchers believe obesity and diabetes are the two most underfunded areas in children’s research. Recognizing the importance of this research, children’s hospitals are taking the lead in exploring the effect high-protein, high-fat diets have on
NACHRI National Association of Children’s Hospitals and Related Institutions
children, conducting clinical trials to find the most effective type 2 diabetes medication for teens, and studying the effects stomach-reducing surgeries have on young patients. NACHRI and its member hospitals also advocate increased federal funding for pediatric research in all areas of obesity and related conditions. At the Penn State Children’s Hospital’s Multidisciplinary Weight Loss Program, Ronald Williams, M.D., and his team combine smaller portion sizes, lowercalorie liquids, and an easy and fun exercise program to achieve the desired weight goals based on the patient’s medical needs.
Children’s hospitals also provide outreach programs that help children and families cope with childhood obesity. Children’s hospitals have created innovative physical activity plans,
designed skills workshops that teach families to make better food choices and forged partnerships with schools, governments and health organizations to develop healthy lifestyle programs. Children’s hospitals also provide targeted care for populations at high risk for obesity, such as African Americans and Hispanics, and offer the nutritional counseling, clinical care and emotional support that children and parents need to successfully lead healthy lives. ❖
Articles in this newsletter are written by professional journalists or physicians who strive to present reliable, up-to-date information. But no publication can replace the care and advice of medical professionals, and readers are cautioned to seek such help for personal problems. ©2004 Health Ink & Vitality Communications, 780 Township Line Road, Yardley, PA 19067, 267-685-2800. Some images in this publication may be provided by ©2004 PhotoDisc, Inc. Some illustrations in this publication may be provided by ©2004 The Staywell Company; all rights reserved.
Cub Chat is a complimentary quarterly newsletter produced by the Office of Strategic Services at Penn State Children’s Hospital. For questions or additional copies, please call 717-531-8606 or e-mail Vanessa Viozzi at vviozzi@psu.edu. pennstatechildrens.com
A. Craig Hillemeier, M.D. Chairman
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Get Active! The goal set out by the American Heart Association is for every person age 3 or older to strive for 30 minutes of continuous aerobic activity daily. This type of activity is anything that “gets your heart rate up and keeps it up.” Exercising with a “buddy” helps keep everyone motivated; being active with your children allows you to spend time with them, and teach them good “heart healthy” habits — and it helps keep you in shape too! Vary your exercise routine to keep you and your child from getting bored. Listening to music helps, too. If you and your child are not very active, begin slowly. Even as few as five minutes a day to start builds good habits. Increase your activity time each week until you get to 30 minutes. Jill Cowen, physician assistant and exercise physiologist at the Multidisciplinary Weight Loss Program, recommends following these guidelines for getting your heart rate up: ■ Ride bikes as a family. ■ If your children participate in sports, practice their sport with them in the backyard. ■ Play tag or “run the bases”: See how fast or how many times your child can touch all the bases on a baseball field. You can
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make your own bases with rags, chalk or cardboard. Walk, hike, or explore a nature trail. Be creative. Encourage your child to make up games with you. Dance to music your child likes. Swim. Jump rope. Use videos such as Elmocize or Tae-Bo®.
Normal response to activity You and your child will feel your heart beating faster, be mildly winded, sweaty and may even have “flushed” cheeks. However, if you or your child experience any of the following during exercise, contact your pediatrician or family physician: chest pain, dizziness, fainting, wheezing, or persistent cough following exercise. ❖