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Finding the Obesity Antidote

School of nursing professor seeks answers to childhood obesity problem in Texas

April 2003

by Natalie Gutierrez

Horse-drawn hearses carrying the bodies of children - victims of the measles, scarlet fever or smallpox - this was a common scene in the late 1800s and early twentieth century. Many who survived were left deformed, blind or deaf. Today, modern immunizations protect children against these killers. However, a new epidemic, for which no vaccination exists, is slowly ravaging the bodies of our children. That epidemic is childhood obesity.

In the past 30 years, obesity in American children has more than doubled. A recent National Health and Nutrition Examination Survey (NHNES), published in the Journal of the American Medical Association, reported that almost 9 million children and adolescents ages 6 to 19 in the United States are overweight. More children are being diagnosed with chronic adult health problems such as Type 2 diabetes, high cholesterol, hypertension and sleep apnea - diseases that can be deadly if carried
into adulthood.

Obesity rates are higher for some ethnic groups. For example, the NHNES found that 12.3 percent of white children ages 4 to 12 are overweight, compared to 21.5 percent of African-American children and 21.8 percent of Hispanic children of the same age. With a population that is now 32 percent Hispanic, Texas children are more at risk than children in any other state.

A new study led by Elizabeth Reifsnider, Ph.D., R.N., W.H.N.P., associate professor of chronic nursing care, is working to unlock the mysteries of the childhood obesity epidemic in Texas. While most research focuses on school-age children, Dr. Reifsniderís project, titled "Causes of Obesity Among Toddlers in the Lower Rio Grande Valley," is unique in that it targets children ages 2 to 4. Dr. Reifsnider was recently awarded a $49,403 grant from the Regional Academic Health Center in Harlingen and a $10,000 grant from the National Institutes of Health to pursue her research.

Although San Antonio recently was named one of the "Fattest Cities
in America," other cities in Texas earned an even deadlier ranking. The
Lower Rio Grande Valley, which consists of 19 counties and eight major cities, was ranked as having one of the highest rates of death from diabetes, nearly twice the state average.

"One way to decrease the morbidity and mortality rates of diabetes is to reduce one of its primary causes - obesity," Dr. Reifsnider said. "There is little research published that reveals what is occurring in families of children during their preschool years to distinguish those who become obese at school age from those who do not. We are working to fill that gap," she said.

Dr. Reifsnider is working with co-investigator Janet Banks, Ph.D., C.P.N.P., assistant professor of family nursing care, and research project directors and Ph.D. students Shannon Dowdall, M.S.N., R.N., and Alma Flores-Vela, M.S.N., R.N., to identify the risk factors for obesity in pre-school-age children. Both Dowdall and Flores-Vela work in Women, Infants and Children (WIC) clinics in Edinburg and in Hidalgo County. They have recruited 50 obese and potentially obese children, 50 normal-weight children between the ages of 2 and 4, and their mothers to participate in the study.

A child is considered to be obese when his or her Body Mass Index (BMI, a ratio of height to weight) registers on a doctorís growth chart to be in the 95th percentile for his or her age group.

"We discovered that we had no problem finding the overweight children in the Valley to participate in the study," Dowdall said. "It is frightening to see how many toddlers are already overweight."

Dowdall said records on both the childrenís and parentsí height and weight, as well as information about eating habits, stress levels in the home, number of people living in the home, and the parentsí education and employment histories are kept and evaluated.

"No parent would willingly expose their children to a potentially lethal disease, yet many are overfeeding their children," Dowdall said. "Our research will help us to determine how the physical, environmental and psychological variables differ among families of overweight children versus those of normal-weight children," she said.

Dr. Reifsnider explained that the Valley is one of the poorest areas in the United States. Its unemployment rate is almost three times the state average. All of the study participants are Hispanic and economically disadvantaged. Many are immigrants from Mexico.

"What we are beginning to find is that the obesity problem in the Valley could very well stem from acculturation issues," Dr. Reifsnider said. "We have observed that less acculturated Mexican-American families tend to have healthier diets that include more fruits, vegetables and fibers. But the longer these families live in the U.S., the more accustomed they become to eating fat-laden foods such as hamburgers, french fries and pizza. Their diets take a dramatic turn for the worse, as do their childrenís."

In addition, Dr. Reifsnider explained that many immigrants come from rural areas in Mexico where their children are accustomed to running and playing outdoors. When they move to the United States, many are forced to live in poor, urban areas where vehicle traffic and crime levels are high. Most parents choose to keep their children indoors in front of a television rather than allow them to play in unsafe outdoor areas. Unfortunately, the children become accustomed to a more sedentary lifestyle.

"The sooner we can detect obesity in children, the faster we can begin to implement successful intervention programs," Dr. Reifsnider said. "We canít wait till these children reach school age, because by then, itís too late."

For the children of the Valley and all of Texas, successful intervention programs could be the antidote that will save our children from the deadly obesity epidemic.


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