Little Kids, Big Problems

We've heard a lot about what it takes to prevent obesity, but what do you do when your child desperately needs to lose weight? The Evans family is finding out, and their lessons can help all of us.
Morganne riding a bike

Amy Postle

For Marianne and Mike Evans, the wake-up call came at the end of a checkup for their daughter Morganne, who was then 6. "We knew she was heavy, and starting in preschool she'd been consistently gaining more weight than she should have," says Marianne, of Youngstown, Ohio. "But this time it was different. It wasn't just that her weight was high. Now her blood pressure and cholesterol level were high too. Her doctor referred us to a pediatric cardiologist."

The scary news may have been lost on the good-natured first-grader who loves to chase Mitchell, her little brother, and Meganne, her big sister, around the yard. But for Marianne, a public-health registered nurse, the idea of Morganne seeing a cardiologist felt like a splash of ice water, and the doctor's suggestion that Morganne might even need medication to lower her cholesterol horrified her.

"I already felt bad about her weight," says Marianne, who also struggles with the scale. "I had recently switched from part-time to full-time work, so I wasn't able to cook the way I wanted to or spend as much time playing. When Morganne would ask me, 'Why can't I be thin like Meganne?' it almost broke my heart. But this was about her health. We knew we had to do something major, and Mike and I were afraid."

In fact, Morganne's situation is a reality for millions of American families. Today, 15 percent of children and adolescents are overweight, and another 17 percent are obese. Since the obesity epidemic began in earnest in the late 1990s, pediatricians have been warning parents about the health problems that overweight and obese children would face in adulthood, including the heightened risk of cardiovascular disease. But today, high blood pressure, a precursor to heart attacks and strokes, is common among children with weight problems. Obese kids -- those whose body mass index (BMI) is at or greater than the 95th percentile, meaning they're as big as or bigger than 95 percent of children the same age and sex -- are three times as likely to develop hypertension as those who are within a normal weight range. Of course, many of these heavier kids also face type 2 diabetes and liver and kidney disease, as well as a greater incidence of poor school performance and being bullied.

However, hypertension can cause symptoms immediately, including headaches and, in more extreme cases, chest pain, blurred vision, and seizures. Marianne knew that her whole family needed to act quickly.

The Cardiologist's Verdict

Morganne's first visit to R. Peter Vande Kappelle, Jr., M.D., a pediatric cardiologist at Akron Children's Hospital in Boardman, Ohio, was in April 2011. He determined that her BMI was 20.6, greater than the 95th percentile. She was no longer just overweight, but obese. Her parents expected Dr. Vande Kappelle to put Morganne on a diet. But experts now recommend treatment plans that are realistic and long-term, not restrictive. "With a child like Morganne, our goal is not weight loss, but to slow her weight gain to an appropriate level," Dr. Vande Kappelle says. He urged her parents to make small and sustainable changes. "By focusing on Morganne's BMI over time, and stabilizing the rate of her weight gain, our hope is that her weight will normalize as she grows taller."

The doctor sent them home to dig up their kids' growth charts, and Marianne did some soul-searching. "Morganne was a normal-weight baby, and a normal-weight toddler, and always active," she says. "But when she was 3, she gained 14 pounds in a single year, and she was in the 90th percentile for weight. It happened again the next year. Now I kick myself for not paying closer attention. We had so much going on: I was pregnant; we were selling our house and moving into a new one; I was working more because of the spread of H1N1, so my dad was helping out by watching the girls. We think maybe Morganne was bored when she got home from preschool and ended up snacking a lot. We were all just rolling along with the craziness of every day and the problem crept up on us."

The night of Morganne's appointment, her mom made an announcement at the dinner table, telling the kids what Dr. Vande Kappelle had said about changing their lifestyle. (She has fiercely avoided using words like fat, heavy, or obese, or referring to Morganne's weight in any way.) "All of us, even Mitchell, are going to be making some changes to be healthier," she explained. "We'll be more active, cut back on sweets, and learn more about choices. This isn't just about Morganne. We're all in this together."

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