When local institutions create a team that includes a doctor, a nurse, physiologists, dietitians, a psychologist and other researchers to tackle childhood obesity, you know they consider the problem more than a passing trend.

Last October, the University of Tennessee Health Science Center (UTHSC) and Le Bonheur Children's Hospital opened a Healthy Lifestyles Clinic as part of their joint Pediatric Obesity Program under the direction of Joan Han, MD, a Harvard-educated endocrinologist and former U.S. Public Health Service officer.

 Exercise – a recommended one hour a day, seven days a week – is a key aspect of the individual plans for clinic patients.

"We know that children are certainly less active now than they've been at any point, and it stands to reason that has impacted their physical ability," said Webb A. Smith, PhD, a clinical exercise physiologist for Healthy Lifestyles and an instructor in pediatrics at UTHSC. 

According to data measured by the U.S. Centers for Disease Control and Prevention, more than 19 percent of high school-age youth in Memphis were obese in 2013, a rate that was 5 percent higher than the national figure. From 2003 to 2013, the number of obese high school-age youth in Memphis increased by 3.6 percent. Children whose body mass index were at the 95th percentile or higher are considered obese and at increased risk for diabetes, cardiovascular disease and osteoarthritis, among other conditions. 

Pediatric health workers say "screen time" often stands between children and exercise.

“I certainly see in my clinical work lots of patients are spending lots of time watching a screen of some sort,” Smith said. Though Wii and Xbox Kinect video games encourage movement, he said, “most screen time is a competing interest in having fit, healthy children.”

Grant Newman, MD, says in his practice at Pediatrics East that he advises families to follow the American Academy of Pediatrics' 5-2-1-0 daily plan. That's five servings of fruit and vegetables per day, no more than two hours of screen time, one hour of exercise and zero sugary drinks.

“We go through that with most of our families, and most of them agree,” he said. “But some (patients) want to negotiate with me on the video games . . . ‘What if I do six hours and then only one hour?’”

A child's screen time must be monitored, he said. “Once they get into that video game, they get in a trance and lose track of all time. They can't enforce it, and they don't have the ability to control whether they do something else.”

Newman, who has practiced for 15 years, said while “the average kid is still pretty thin in elementary school, there's a trend in early middle school toward kids getting heavier.”

“Sometimes I feel like 'Where are all these obese kids you hear about?' I'll go days when I see thin kid after thin kid." But he says they most often "come from active, athletic families.”

Monitoring the body mass index, the body fat measure based on weight and height, on a growth chart is a reliable way to detect problems, he said.

“You may have a kid whose BMI is steadily in the 75th or 80th percentile, and that's probably OK. But if they go from the 30th to 50th, to 75th to 80th percentile, we look at that differently. After the first few years of elementary or middle school, that usually coincides with being less active and what they're eating.” 

The approximately 250 patients who've been referred to the Healthy Lifestyles Clinic at Le Bonheur have BMIs that are at least in the 95th percentile, which means they're candidates for serious health problems related to their weight.

“We try to encourage increases in physical activity, optimally at least 60 minutes of activity each and every day," Smith said. "We also counsel them to spend no more than two hours a day either looking at a screen or playing a game of that sort.”

The plans are tailored to individual families.

“Some families are ready for us to give them a specific program and work with us directly,” Smith said. “They're interested in what exercise to do, how many times to do it, how hard should they push. Other families are more interested in trying to make some basic changes like just going for a walk.”

The clinic monitors at-home exercise by asking patients to keep journals and notes on their activities and with fitness trackers. "We also have them walk us through their exercise to see how proficient they are at it,” he said, “which is usually a good indicator of how many times they've tried.”

And while doctors and clinicians worry about children who get too little exercise, they also worry about those who get too much of one kind.

In July, when pitcher John Smoltz was inducted into the National Baseball Hall of Fame, he criticized the trend toward early specialization in youth sports, saying it could lead to injuries. He said he wanted parents to realize "that you have time, that baseball is not a year-round sport. That you have an opportunity to be athletic and play other sports." (Had he gone to Michigan State instead of signing a professional baseball contract, Smoltz planned to walk on to play basketball.)

A recent study by the National Institutes of Health found: "For most sports, there is no evidence that intense training and specialization before puberty are necessary to achieve elite status. Risks of early sports specialization include higher rates of injury, increased psychological stress, and quitting sports at a young age."

Smith also laments the phenomenon.

"Awhile ago when I was playing sports, baseball season was a season, and it ended and you had to find another thing to do. So you played football or you played basketball," he said. "Now the way youth sports is structured, it's reasonable that you can play your specific sport year around, or at least train for it. 

"I think those athletes that specialize really early are more likely to have injury issues, and I would argue that you're not developing them into the best athletes they can be.”

“There's been some data here in the last couple of years show that those who are pushed hard early actually are less likely to be lifelong exercisers,” he said.  “As an exercise physiologist, I would rather see children learn a diverse group of activities they can continue throughout their lifetime. I think that in a lot of ways the sport is the culmination of the training, and the training is what you want them to fall in love with.”

He pointed out that in recent years at the NFL Combine for college players hoping to play professionally, "a shockingly high number played multiple sports in high school." Tracking Football's website reported that 224 of the 256 players at this year's NFL entry draft were multi-sport athletes in high school. 

Smith observes, “So it goes back to the idea that if you're trying to raise a professional athlete, then you should focus on raising an athlete.” 

PHOTO:

Head shot of Webb Smith. Also several charts/graphics.

Webb Smith

RELATED LINKS:

Le Bonheur Children’s Hospital, www.lebonheur.org

University of Tennessee Health Science Center, www.uthsc.edu;

Pediatrics East, www.pedseast.com