Winnipeg Free Press - PRINT EDITION
Posted: 08/31/2013 1:00 AM | Comments: 0
It's a sunny afternoon in a strip mall on Corydon Avenue and Rowan Smith is getting her workout on, starting with "tummy time."
She's on her hands and knees, down on the floor with about a dozen others in the gym doing the same routine. The speakers are blaring the Bee Gee's classic Stayin' Alive. The instructor says the exercise is good for her back, arms and neck muscles.
Rowan doesn't miss many classes, and she's beaming through most of the workout. But it's difficult to know what routine she looks forward to the most.
You see, Rowan Smith is six months old.
"People think it's hilarious," says Tara Smith, Rowan's mother. "I tell them she (Rowan) has to go to the gym today. She has to get her workout in."
Smith is sitting on a mat with Rowan in her arms. Around them are eight other mothers and infants participating in the Little Bundles class at My Gym, a fitness centre that opened in Winnipeg last September. The clients range from six weeks to 13 years old, and already the facility, which includes a balance beam, climbing wall, trampoline and zip line, has 250 members. Another My Gym is slated to open in St. Vital at the end of the year.
Smith is a high school teacher at Garden City. Every day, she sees children transfixed to iPods and video screens, a 21st-century dilemma that has health-industry experts making ominous warnings about the potential increase in future obesity rates that are already climbing to unprecedented levels.
Call them Generation XL.
The numbers, like the weigh scale, don't lie. In 1978, only 15 per cent of children were overweight or obese. By 2007, Statistics Canada found 29 per cent of adolescents had unhealthy weights. By 2040, if trends continue, up to 70 per cent of adults aged 40 years will be either overweight or obese.
Smith is determined daughter Rowan won't be in that 70 per cent.
"The younger you get them involved in physical activity and away from screens...," Smith says. "I teach high school. They're glued to those things. Who knows what it's going to be like for her (Rowan) when she's older?"
Who knows, indeed.
A decade ago, there were no industry standards to accommodate bariatric or obese patients in Manitoba hospitals. Today, due to new Canadian Standards Association guidelines, approximately 15 to 20 per cent of Winnipeg Regional Health Authority facilities in Manitoba are being fitted to bariatric standards.
Some literature suggests facilities should be prepared to accommodate patients upwards of 455 kilograms (1,000 pounds). This means bigger hallways and recovery rooms, wider doors, larger ambulances... even bigger toilets and wheelchairs.
"This shift," according to the WRHA, "requires a brand-new approach (to the) health-care delivery continuum, through inpatient, ambulatory and outpatient settings. Their physical needs and conditions are highly specialized and require changes to the design of just about every space within the hospital environment."
Welcome to the future, and it's fat.
But it's not the current state of obesity in Canada, where studies estimate approximately 60 per cent of Canadians are either overweight or obese by BMI (body mass index) standards, that has researchers and scientists most concerned. It's the children.
According to a World Health Organization survey, an estimated 43 million preschool children were overweight or obese in 2000, a 60 per cent increase from 1990. By 2020, if current trends continue, nine per cent of all preschoolers (60 million) will be obese or overweight, the study concluded.
In Canada, obesity rates among aboriginal children are even higher. A 2011 report by the Public Health Agency of Canada and the Canadian Institute for Health Information found nearly 33 per cent of aboriginal children between the ages of six and eight who were living outside First Nations communities were obese, as were 13 per cent of children age nine to 14.
In fact, there is a relatively new player in childhood obesity: Type 2 diabetes, which in past generations only existed in the adult population. It was a disease physicians and scientists believed took years to develop. Not anymore.
Type 2 diabetes in children was first discovered by Dr. Heather Dean, now a professor of pediatrics and child health at the University of Manitoba's Faculty of Medicine. But while aboriginal child obesity rates (and those of Type 2 diabetes) are higher than average, the general population among Canadian kids is experiencing a growth spurt, too.
"There's no question it's changing," says Dr. Elizabeth Sellers, a pediatric endocrinologist with the WRHA and one of Canada's leading diabetes experts. "Your mind gets warped. You look at a child and you think, 'They're not that heavy, just a little chunky. But when you actually graph them on a body mass index chart they're really quite obese. But you get used to seeing kids... you begin to think a little extra padding is normal, but it's not. And that's changed pretty rapidly.
"The obese child in my grade school stood out as the exception. We're now looking at about a third of kids who are overweight or obese."
Adds Dr. Jon McGavock, an associate professor with the U of M's Faculty of Medicine and a researcher at the Manitoba Institute of Child Health: "My brain has shifted. You don't know what's normal anymore. I've spent so much time with heavier kids."
Kids aren't just at risk for diabetes. Dr. Allison Dart, a pediatrician with the Manitoba Institute of Health who specialized in renal research, is seeing more and more cases of children with high blood pressure and kidney problems.
"That was never the case in the past," Dart says. "It's been an issue for a long time, but it's shifting to younger generations. So the kids have all the health problems that the adults do. Before, the kids were relatively healthy and when they became adults they started having problems. Now we're seeing kids with high blood pressure, high cholesterol, protein in their urine. These are problems that 60-year-olds used to have, now we're seeing them in 10-year-olds.
"They're on dialysis when they're 35, these kids," Dart adds. "It's horrible. I see every day in the clinic what's happening and it's really sad. I'm seeing kids that are unhealthy -- probably some genetics but mostly what they're being fed and what they do day to day.
"I mean, kids should not be dealing with those complications. They should be dealing with school and their sports activities and their friends and what they want to do when they grow up. But these kids are taking pills to make their blood pressure better and they're injecting themselves with insulin."
So what happened? Or, more accurately, what is happening now? Experts cite myriad factors.
"We live in a society that's designed to make our lives easier," McGavock says. "Thirty years ago, kids had to walk further to school, kids were less likely to get a ride to school. The area around the kid's home where they could walk or travel was way bigger."
In addition, as grade school sports programs become more competitive, kids are more likely to decide whether they are going to be an athlete or not earlier in life, McGavock says.
Screen time also plays a factor. In 2004, about one-third of children aged six to 11 logged more than two hours of screen time a day, according to StatsCan. Currently, the screen-time average is closer to eight hours and only 19 per cent of kids aged 10 to 16 meet the two-hour guideline. The average Canadian child spends three to five hours a day in front of a TV. Sellers says of past generations: "You didn't sit on MSN or Facebook for an hour at a time. Your mother kicked you outside." But if you suggested the two-hour minimum to most adolescents "they would laugh."
Throw in increased portion sizes for meals, the preponderance of sugar drinks, the declining accessibility of play structures in many neighbourhoods (most suburbs built in the last two decades don't even include sidewalks) and the resulting obesity rates shouldn't seem shocking. Or even surprising.
Dr. Dean Kriellaars, an associate professor of medical rehabilitation and exercise physiologist, contends children of the "bubble wrap" generation are more susceptible to weight issues. There was a time, Kriellaars says, when most children would play out in the neighbourhood until dark.
"Nowadays, we'd never let our kids do that for fear, and inappropriate fear, that they will be stolen by a white van," he says. "We don't even let our kids walk to school because we're afraid of immediate danger. That's hysterical behaviour on our part. And by being overly protective, we're making our kids physically illiterate.
"Very few kids go out in the real world. It's called 'nature deficit disorder.' Our kids don't even know how to play in a natural environment anymore. Everything is structured. Our freedoms of our children are highly restrained.
"A mother might think, 'I bring my kid to soccer three times a week and it's an hour long.' Well, they're not getting three hours of moderate physical activity from soccer. If they're a goalie, they might be getting three minutes. They need 60 minutes a day. Minimum."
At the very least, Kriellaars argues, parents should demand schools emphasize, not reduce, the physical education options in the school system.
"Parents need to understand that physical education is the health of their child," he says. "If my kid's not reading, aren't I coming to the school and asking, 'Why isn't my kid reading?' You should be going up to the phys-ed teacher and saying, 'Why isn't my kid active?' "
The modern-day parent will take every precaution -- seatbelts, helmets, constant supervision, child-proofing the home -- yet will often ignore critical components of both fitness and obesity, the latter of which can manifest itself in diabetes, heart disease, kidney disease and cancer.
"We will kill our kids slowly," Kriellaars says, "but we won't kill them quickly."
On a biological level, addressing childhood obesity involves the same calculations as adults: calories consumed versus calories expended.
But researchers are beginning to uncover what they believe plays a key role in early weight gain that can last a lifetime -- adverse effects of "toxic stressors" in early childhood development.
Evidence is mounting environmental stresses -- poverty, abuse, childhood trauma -- are linked to obesity.
Dr. Rob Santos, scientific director of Healthy Child Manitoba and research scientist for Manitoba Centre for Health Policy, refers to this development as "the new frontier."
A decade ago, the focus of research and policy revolved around physical activity for school-aged children and adolescents, Santos says.
"What's so dramatic now is we're finding how much is occurring before children are even born," he says. "What's passed on inter-generationally, not just in terms of family practice but epigenetics."
Simply put, epigenetics is the science of how the environment can alter gene expression. For example, if an individual has inherited genes that increase the risk of alcoholism, are there environmental factors that can turn that gene on or off?
In the case of obesity, researchers are trying to determine what environmental factors can trigger genes that can lead to overeating. Conversely, what environmental factors in early childhood development can help create a healthy lifestyle?
Scientists call it "biological embedding."
"If you grow up in a place where you don't have self-esteem and you don't think you're worth anything, and you don't have any ability to overcome those challenges, you're going to continue to have high levels of stress," Dart says. "But if you can learn to feel good about yourself, have a good body image, to have social supports around you... then you'll have a better outcome."
"There's no destiny here," Santos adds. "We can improve these things by changing the way we live, the kinds of communities we create, because they directly impact whether our DNA is expressed or not in different ways."
This could mean emphasis on back-to-basics, such as the simple activity of play.
"Those things are important to all children," Santos says. "And they've been important ever since we've had brains. In the case of obesity, are we making more play stations available for children and families? Are we making recreational opportunities available? Are we making the healthy choices easier?"
Far more difficult is addressing factors of poverty, in particular in terms of obesity and Type 2 diabetes rates in aboriginal communities.
Says Santos: "All the misery statistics are not surprisingly correlated."
Seated at the same table as Santos, on the second floor of the Manitoba Legislative Building, is Kevin Chief, the province's minister of Children and Youth Opportunities.
Chief understands the potential ramifications of early childhood development. His father, Norman, born and raised on a First Nation in western Manitoba, died at age 63 after suffering from alcoholism and diabetes. Norman Chief was also overweight and had suffered several strokes.
Son Kevin, who went on to earn an athletic scholarship with the University of Winnipeg Wesmen basketball team, credits his athletic environment for his passion for fitness. Chief currently serves as director of the Winnipeg Aboriginal Sport Achievement Centre.
Now the MLA for Point Douglas, Chief says his views on early childhood development, in relation to fitness, are seen through the eyes of his two-year-old son, Hayden.
"I'm much more knowledgeable about how to keep my son active at a very young age," Chief says. "I understand the more active he is throughout the day, the easier it is to get him to eat healthy foods."
Hence Chief's philosophy. "You have to actually think about it before someone is even born, the prenatal stage," the minister says. "The sooner we invest, the better off we'll be. It's much more cost-effective to invest in a young person who's two than when they're 22."
In 2001, the province began offering a prenatal benefit for low-income mothers, for example. Another program, Wiggle, Giggle and Munch, is now available at more than a half-dozen inner-city centres, which offers preschool children and their parents health and nutritional education and fitness/play activities.
Chief refers to other programs, such as Starting Early, Starting Strong and initiatives now being funded by the Winnipeg Jets True North Foundation, which has developed a hockey program for inner-city kids.
But can the big-picture problem really be addressed by a series of unconnected, disparate youth programs?
"You can think, 'Holy, this is going to be tough. Every single thing you look at is about challenge, is about hardship, is about impossibility,' " Chief says.
"Then it's going to be difficult to get anything done. But if you look at it from the perspective of 'what can we do today?'... what you have to understand is doing it by yourself is not possible. It's going to take a shared responsibility. And you have to pick something and move towards doing it.
"Things can get better. Even young people and families that deal with the most toxic stressors. You just have to match those things up."
Santos, meanwhile, believes the emphasis on early childhood development is a "golden moment" in the battle against childhood obesity. "Ten years ago, you wouldn't have seen any of this," he says. "Things are starting to realign. Opinion leaders, policy leaders, community leaders all getting excited about the same thing. That's how you mobilize people. That's what's happened with every other major health movement in history.
"We can make a difference at any age. But you can have the biggest and longest-lasting impact the earlier you start, because of how the brain develops. That's where everything starts. The brain is like an RRSP. You invest early and over time it grows through compound interest."
In fact, Santos argues future policy on early childhood development won't just impact childhood obesity rates, as data and funding follow the research.
"Not just for obesity, but for everything that matters," he says. "Everything you care about. Whether it's graduation rates, aboriginal communities, economic productivity, global competitiveness. It's the same principles. I think it will happen sooner than people think.
"Most people who are working on battling obesity don't often think of themselves as also promoting academic achievement or promoting economic development or promoting mental health (but they are). Why? Because it all intersects in the brain."
Back at My Gym, owner Tamara Simon says the chain, which originated in California three decades ago, now has franchises worldwide, including Europe, the Middle East and Asia. Her location is the only one in Winnipeg and the third in Canada.
Simon has three young children, aged two, five and seven. They have never set foot in a McDonald's. They've never had a soft drink. The only computer in the home is off-limits for video games.
"Obviously, as we evolve as a society, we learn more about what it means to be healthy," Simon says. "Some people just don't know. But at the same time, it's your responsibility to instil that in your children so they have longevity. Unfortunately, some people just don't get it. That's the problem, right? You're setting up your children to fail.
"And what did the kids do? They look up to you. They do everything you tell them. You can be a fabulous parent, but you still don't know the impact food has on you and your children."
For example, did you know experts believe orange and apple juice is one of the worst culprits of sugar distribution? Or that most breakfast cereals marketed to children are the least healthy option to start the day?
Simon admits, as most parent understand, "it's a constant battle." Do you reward your children with sweet treats? Do you let them eat hotdogs or mounds of potato chips? Do they have enough accessible activity in the neighbourhood? How much do you restrict their screen time?
Still, Simon's compass is guided by a simple mantra in a complicated world: "French fries, pizza, hotdogs. French fries, pizza, hotdogs. Just think of what you're putting in your child's body. How's your body supposed to function properly if you're constantly feeding it garbage? It's nourishment.
"I'm not saying go extreme. Just slowly peel back the layers. You want chips? Have baked chips. Have a baked potato. Instead of frozen vegetables, have fresh vegetables. You want pleasure? Go for a walk outside with your children. Go for a bike ride. Go to the playground. Go swimming, go tobogganing. Don't teach your kids that pleasure is sitting around eating a piece of cake."
For Dart, who deals every day with the hard reality of childhood obesity, the key is evolution, not just in education, but attitude.
"Being healthy takes a lot of effort," the pediatrician concludes. "It comes back to that resiliency, too. If you don't think it's worth making the changes, why would you do it? That's why it's not getting any better fast. It's hard to make those changes for everyone. But that doesn't mean we shouldn't try. And every little thing is going to make a difference eventually.
"Telling people what to do... it doesn't work. Getting them to think they want to do it -- that works."
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Republished from the Winnipeg Free Press print edition August 31, 2013 ??65528
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