Within the past decade, it seems, Americans have become increasingly aware of a rampant epidemic. Televised public service announcements tell us of its dangers, encouraging parents, teachers and doctors to watch for the signs and symptoms.

Kathy Shadle James, DNSc, CNP, is an associate professor of nursing in the Hahn School of Nursing and Health Sciences at the University of San Diego. Dr. James also maintains a private practice, providing weight counseling for obese adolescents and their families, encouraging healthy lifestyle changes, meal-planning and obesity interventions. "Many of our lifestyle habits are truly increasing our risk factors, from an early age, for a number of health problems in adulthood," says Dr. James. "These include diabetes, high blood pressure, polycystic ovarian disease in women and heart disease; not to mention unseen factors such as low self-esteem, diminished body image and even depression." Recently, Nutritional Wellness had a chance to speak with Dr. James and get her thoughts on meeting the problem of childhood obesity head-on, and taking measures to avoid the potentially life-long consequences surrounding this condition.

NW: First, give us a little background information for our readers. How long have you been teaching at the college level? How long have you maintained a private practice?

KJ: I actually have a doctorate in nursing science and am a family and women's health nurse practitioner. I received my master's degree and doctorate from the University of San Diego. I am a tenured faculty member and teach in the graduate program. I have been at USD for 10 years.

To think that one in three children will develop diabetes due to obesity is frightening. Doctors can help by increasing parents' knowledge and making them aware if their child is overweight and at risk for health problems.

I have had a private practice for 24 years working with families with weight concerns. I used to provide group programs, but now I work with individual families. In addition, I provide the same services in a family practice setting where I am usually counseling for high cholesterol, blood pressure and diabetes related to obesity.

NW: What motivated you to start your weight and health management private practice?

KJ: What led me to start my private practice is this: I lost 60 pounds about 24 years ago. At that time, there were many quick weight loss centers that would advertise – “Lose 5-10 pounds a week.”

NW: Did you lose the weight through one of these weight loss centers, or on your own program?

KJ: I lost the weight on my own. I stayed off the scale during the two years that it took me to lose the weight. I focused on eating when I was hungry and stopping when I felt “just satisfied.” When I was tempted to eat due to emotions, I worked at checking in with myself to see what I was feeling and to identify my needs. It’s a baby step process, but it works.

NW: Have you seen solid evidence of the rise in childhood obesity in your office?

KJ: Yes. I have seen an increase in obesity, with the number of patients who come to my office, and in schools. It’s everywhere, affecting all ages.

NW: So you’re seeing younger patients these days for weight loss counseling?

KJ: I continue to work with families who have “chubby” children. We work together at finding things the family can (and areas in which they are willing to) change. Sometimes it’s about teaching parents how to set limits, like limiting TV to one show or requiring one hour of physical activity per day. Some families allow TV on weekends only. In contrast, some parents don’t have any rules related to TV.

NW: The media would have us think that much effort has been made as of late to make school lunches healthier. For example, banning soda and candy machines, removing whole milk from the lunch line and replacing it with skim, etc. Still, childhood obesity and diabetes are on the rise. It seems like an impossible battle. What will it take to effect positive change in the health of school-aged kids?

KJ: There have been many legislative changes in California and in many other states to improve the nutritional environment in schools. There need to be system-wide changes.

NW: What do you mean by "system-wide?" Do you mean changes and/or legislation at the federal level?

KJ: I am referring to systems beginning with the family, school, community and legislation. Hopefully, this will occur throughout the U.S. To think that one in three children will develop diabetes today due to the high incidence of obesity is frightening. System-wide change won't happen overnight. Parents and families can help, schools can help and communities can help by increasing availability of inexpensive fresh foods at farmers markets; health professionals can help by increasing parents' knowledge and making them aware if their child is overweight and is at risk for health problems such as diabetes.

NW: You say "schools can help." What are some practical measures schools or school administrators can take to help the situation?

KJ: Schools can take a look at what they are offering to children in vending machines. Children nor teens consume sodas if they are not offered. The common meals that schools offer according to parents include burritos, nachos, chicken wings and pizza. Some schools are starting school-wide efforts to improve lunches and are offering salad bar items. As far as the typical candy or cookie sales to raise money, they might consider substituting sales of wrapping paper or journal subscriptions instead of candy.

NW: Whose responsibility is a child's health? Parents? Children? School administrators?

KJ: Health responsibility begins with the parents setting good examples. At home, parents have to remember that they are in charge and make the family rules. They buy the food that comes into the home; they set the limits on TV and computer time. They have a big responsibility. A recent Kaiser report indicated that children, ages 2 to 18 play video games, computer games or watch television for an average of 5 hours and 29 minutes per day.

NW: Another concern is that an adult can lead a child to healthy foods, but can't make them eat. Despite a parent's (or other model's) best efforts, to what extent is healthy eating simply up to the willful child, or even left at the mercy of peer pressure (e.g., "But all my friends eat Twinkies at lunch!")?

KJ: Parents are responsible for providing the healthy foods and regular times to eat, while kids are responsible for how much they eat. [Kids] have good thermostats for the most part and can self-regulate unless parents have been saying "Stop, you have had enough." If there are not "emotional" issues, most children are pretty good at listening to these signals.

NW: So, when parents tell their children when to be finished, rather than allowing their children to learn to feel satisfied, problems can result?

Families have to decide together to make nutrition a priority. Parents are responsible for providing the healthy foods and regular times to eat.

KJ: Parents should avoid food struggles. Over-restriction hasn't been reported to be effective and may contribute to sneaking or hiding food and even possible eating disorders.

NW: As I recall from elementary school, it seemed that the thin kids ate the same cookies and candy at lunch that the heavier kids ate. So, how much do genetics play a role among overweight children?

KJ: Thin kids eat Twinkies and junk just as some overweight children – the thin kids also end up with high cholesterol levels and risks for heart disease as well. Genetics do play some role; but lifestyle is a big contributor.

NW: So, in other words, just because you can't see the effects of a poor diet, doesn't mean such a diet is not detrimental?

KJ: I'm suggesting that just because a child is thin doesn't necessarily correlate with a healthy diet. I have counseled many families with children who are at a normal weight and have cholesterol levels off the charts; usually due to frequent fast food meals and poor choice of snacks.

NW: How can parents get their children involved in their own wellness? Do you have any advice to help parents make the pursuit of proper nutrition more fun?

KJ: Families have to decide together to make fitness and good nutrition a priority. If you have a picky eater, involve the child in selecting two new fruits or vegetables to try that week. Sometimes I have them grade the new food, just for fun. Family members may take turns planning different activities each day or to do together after work or on weekends, like playing ball, going to the beach to play Frisbee, rollerblading in the park, swimming, playing basketball together, etc. Some families buy pedometers and track their daily steps. Ten thousand steps a day is a good goal; which is about 4 miles.

NW: Any closing words of encouragement?

KJ: Healthy families should be a priority for all of us! For tips and detailed advice, check out www.mypyramid.gov or my Web site, www.askdrkathy.com.

NW: Thank you.

As Dr. James stated, a substantial change in the rate of childhood obesity is not going to take place overnight. Clearly, parents, teachers and other authority figures carry a huge responsibility when it comes to the health and well-being of impressionable children. But, this does not exclude the responsibility of a doctor to emphasize the value of healthful habits to their young patients. Children need to hear the gospel of nutrition from all sides – especially from their doctors. When children begin to understand the importance of smart food choices, they will feel the results on both the physical and emotional levels, contributing to vital, lifelong patient-doctor relationships.