Over the last 20 years, the problem of overweight and obesity in children has increased to the point of being the most common health problem facing US children, according to a report in the Journal of the American Medical Association (Vol. 286, No. 22:2845-2848).

The report said that obesity is especially a problem for African-American and Hispanic children, and boys in general.

The day after the article was published, US Surgeon General David Satcher, MD, held a press conference to note that 300,000 Americans a year die from obesity-related illnesses, which may soon overtake tobacco as the leading preventable cause of death in this country.

While the problem is a national one, solutions begin at home, said lead author Richard S. Strauss, MD, associate professor of pediatrics at University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in New Brunswick, N.J.

"Parents should limit TV and video games to less than one to two hours per day, as well as juice and soda to less than seven to 12 ounces per day," Strauss said. "The family dinner table needs to be brought back. Meals should be planned and eaten as a family at the dinner table, and not on the run or in front of the television."

"Finally, frequent snacking and eating is often a sign of boredom," Strauss said.

He quoted Hilde Bruche, MD, a renowned child psychiatrist and expert on eating disorders.

"[Bruche] summed everything up best 25 years ago: 'If a child is fed when he is hungry, played with when he needs attention, and encouraged to be active when he is restless, he is not likely to grow up inhibited and passive or overstuffed and helpless, unable to control his eating because every discomfort is misinterpreted as a need to eat.' "

What does weight have to do with cancer? A lot, said Colleen Doyle, MS, RD, director of nutrition and physical activity for the American Cancer Society. Overweight and obesity are associated with increased risk for cancers of the breast (among postmenopausal women), colon, endometrium, esophagus, gall bladder, pancreas, and kidney.

"Because childhood behaviors frequently track into adulthood, it’s critical that we work to instill good habits in children — not only by trying to teach children, but by working to change the environments in which kids spend their time," Doyle said.

"For one thing, decision-makers in school districts, state legislatures, and at the federal level need to understand the urgency of this issue," Doyle said. "Overweight and obese kids today mean higher healthcare costs and disease rates in the future."

"Childhood overweight reflects the convergence of many biological, economic, and social factors," wrote Strauss and co-author Harold A. Pollack, PhD, of the School of Public Health at the University of Michigan in Ann Arbor.

The authors urge strategies that take into account the culture that surrounds children.

"Overweight arises from multiple causes, some as intimate as the family dinner table, others as seductive as television, or the latest children's video game," they wrote.

The fact that kids find high-fat meals and snacks at school is both a powerful temptation and a signal that these foods are the accepted nutritional norm, according to the article.

"Like adolescent smoking, teen pregnancy, and youth violence, childhood overweight is prevalent because it arises from deeply rooted behaviors and from social practices that are hardly confined to children," the authors wrote. "Given the profound consequences of childhood inactivity, poor nutrition, and overweight throughout the lifespan, urgency is warranted in responding to this epidemic."

Among African-American children between the ages of four and 12, 21.5% were overweight by 1998, according to the report. Among Hispanics, 21.8% of children were overweight. Among non-Hispanic whites, 12.3% were overweight. In all groups, however, the percentage of overweight children had increased, and those who were overweight were heavier than in 1986.

The issue is alarming and the obstacles many, but there is a glimmer of hope for real change, said Doyle. For example, she said, some states, such as California, are working on legislation that influence school district policies toward more fit children.

"I think probably the biggest glimmer is that slowly but surely the issue of childhood overweight and obesity is getting national attention," Doyle said.

Parents can push for change at the local level, Doyle said, especially at schools and other places where children spend a lot of time. Parents can ask for:

• More physical education — and make sure kids are really active during class
• Healthier school meals and less exposure to junk foods
• More sidewalks so kids can walk to school, and other safety improvements where children can be active.

"Kids are the target of big-time marketing dollars," Doyle said. "All you have to do is turn on the TV during any kids program and see evidence of this. And those marketing dollars are not promoting vegetables and fruits!"

Not only are kids sitting during a lot of their school days, but they're susceptible as a captive audience to marketing strategies such as free pizza from a popular chain if they read a certain number of books, Doyle said.

"Evidence suggests that for many children, the majority of fruits and vegetables consumed, and even the majority of foods consumed, are from school meal programs," Doyle said. This is especially true for lower-income children.

To determine what weight is normal for children of a particular age and height, parents can consult the CDC's new pediatric growth charts.

"Another way — eyeball them," Doyle said.

"Growing children have extremely high nutrient needs," Doyle said. "Limiting calories should not be the first defense in weight loss unless under the advice of and monitored by a physician and registered dietitian.

"Parents should take special care, however, to be sure healthy foods are available and accessible,” Doyle said. “You not only have baby carrots in the house, but they are in the fridge in a place that kids can easily see and get to. Keep a bowl of washed apples and ready-to-eat bananas on the counter."

Although children under the age of two should not be fed lowfat diets, after that age you can start using reduced-fat dairy products and lean meats, Doyle said.

Limit how many cookies, chips, sodas, and other high calorie/low nutrient foods are in the house. Substitute healthier vegetables, fruits, and whole grains. That helps control calorie intake but still meets high nutrient needs, Doyle said.

"The other critical side of the equation is physical activity,” Doyle said. “Physical activity is an important strategy for weight control — and fun — in children. "And one of the biggest indicators of whether children are active is whether their parents are."