Obesity: Facing Up to It

American adults are getting fatter, and so are their children. The stats are pretty staggering:

• Only Colorado can claim that less than 20% of their citizens are obese.


• Blacks have a 51% higher prevalence of obesity compared to whites, and Hispanics have a 21% higher rate of obesity.


• 12% of American kids ages 2-5 are obese. That number goes up to 17% of kids ages 6-19.


• 80% of kids who are obese at ages 10-15 are obese as adults. This leaves them at risk for heart disease, high blood pressure, and diabetes.

I think we can all agree that there is a problem here. That's why I am very proud of First Lady Michelle Obama for launching a major childhood obesity initiative . While it isn't the government's job to pay for weight loss programs or fitness club memberships, the spotlight may raise awareness and offer constructive tips for many Americans. I hate to say it but... we've all got to take personal responsibility and make changes in our lives to turn this obesity epidemic around. And yes, it is very hard to break bad lifestyle habits.

Here are a few simple changes you can make:

1. Buy skim milk instead of 2% or whole milk.


2. Offer water as a beverage (crazy idea, no?)


3. Don't stock the pantry with juice drinks, sports drinks, or sweetened beverages (i.e. soda).


4. Plan ahead and cook more meals at home-so you don't end up picking up fast food or to-go.


5. Grill foods instead of frying them.


6. Make scheduled times to exercise. Don't just try to "get around to it".


7. Exercise as a family, instead of watching TV as a family.

Mrs. Obama has taken some heat for telling the world that her own daughters have had been overweight. Critics say the girls are at a vulnerable age for body image issues; sharing their body mass index with the entire world is inappropriate, even if it is for the better good. Supporters claim it shows that no one is immune to this problem.

I agree with both arguments. So, I asked my daughter what she thought about it. Her comment: "Well, I hope Mrs. Obama got permission from them before she said that! It's their body and they should get to decide if the world should know."

I'm curious to know what you think!

- Ari Brown, MD, FAAP

WebMD Parenting & Children's Health Newsletter - Must-have children's health news

MMR Vaccine Study: A Lesson for Us All

radical.librarian
/ CC BY 2.0

I tried to avoid blogging about this topic, since I've spent 12 years dealing with it (and I'm sick of it!). But since it is the lead medical story of the week...

The esteemed British medical journal, The Lancet, retracted a little case report they published 12 years ago.. This is a pretty historic event in the world of medicine. But, do you care? If you are a parent who has spent any time wondering about vaccine safety, you should.

This "little case report" tried to link the combination MMR vaccine to autism and it was the shot (literally) heard around the vaccine world. And, when I refer to it as "little", I am not kidding. Just 12 patients were researched regarding bowel problems and a possible association to autism. The 13 researchers (yes, there were more researchers than patients being studied) inferred that these children developed both intestinal problems and autism from receiving the combination Measles-Mumps-Rubella (MMR) vaccine. They did not prove a link at all.

But, that did not really matter to the media who took the story and ran with it. This was the esteemed journal, The Lancet, after all, and their acceptance of the paper for publication made its findings important, right? Wrong.

The research methods were seriously flawed. While the paper said, "We investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder," the children who were studied did not just randomly show up at the hospital. They were cherry-picked. And, these kids underwent invasive tests that were not approved by the ethics committee who reviewed the research protocol. Reportedly, someone involved with the study paid to use their children’s friends’ blood for "normal" samples to compare to the affected children used in the research. Beyond being unethical and unscientific, it's creepy.

Last week, Britain's General Medical Council (after over a year of investigations) concluded that the lead researcher of the study was guilty of 30 counts of medical misconduct and a "callous disregard" to the children whom he studied.

"That was a damning indictment of Andrew Wakefield and his research," Dr. Richard Horton, the editor of The Lancet, said to the New York Times on February 2, 2010.

Controversy and medical misconduct aside...let's look at the science. The hallmark of good scientific research is that other research labs produce similar results when they attempt to repeat the work. And yes, other labs have tried to do this over the past 12 years - unsuccessfully.

As a physician, I base my medical decisions on good science. And as a parent who makes medical decisions (like vaccinations) for your child, that's what you should do, too. Don't take any medical study at face value and believe it because it is published or makes the news. Have an intellectual discussion with your doctor about it!

- Ari Brown, MD, FAAP

WebMD Parenting & Children's Health Newsletter - Must-have children's health news

Shots for Tots...Thanks Bill!

Okay, so Bill Gates and I are not on a first name basis...but I do want to thank the man and his wife, Melinda, for donating $10 BILLION dollars to vaccine research and allocation of vaccines to developing nations. It is projected that this gift will save about 8 million children's lives. Wow.

As a pediatrician practicing in the age of vaccine skepticism, I hope the Gates Foundation heroic efforts to save lives by vaccination registers with this generation's parents. One only needs to look at the stats (from smallpox to today's rotavirus vaccine) to see that vaccines do their job. Vaccines have a proven track record of being one of the most effective ways to protect us from serious infectious diseases. But now, more than ever in my career, I have to prove that to families who (ironically, thanks to vaccines) are unfamiliar with vaccine-preventable diseases.

Every year, I teach a class at my child's school about infections and how to avoid them. The highlight of the lecture is when the kids get to see what head lice and pinworms look like under a microscope - totally gross-which means it is extremely popular! Well, this year I updated my talk to include H1N1. It's not often that I get to talk about a NEW germ!

H1N1 Virus: CDC

I took an informal poll. About half of the class told me that they had H1N1 illness. Another quarter of the class said they got the vaccine for it. But, there were a few kids who did not raise their hands to either question. One child, sitting on the front row, told me that his mom said he didn't need to worry because he wouldn't get sick. Okay...I thought to myself...did this child have superhuman powers of immunity or was his mom completely clueless as to how germs spread? Maybe I should include an accompanying lecture for parents for next year!

In my talk, I show a slide of a gentleman sneezing without covering it with his hand or elbow. The secretions from his mouth and nose spray about six feet in the air. I reminded this child with superhuman immunity in the front row that if I had H1N1 and coughed right now, he would be the unlucky recipient of this unpleasant virus. And he would have a very good chance of becoming ill, because he really did NOT have any immunity to this virus. I hope he went home and taught his mom something that day.

After my presentation that morning, I went back to the office to see patients. After at least a month of not seeing anyone with the flu, I had two children test positive for Influenza A-which most definitely is H1N1-based on what state virology labs are seeing right now. We aren't done with H1N1 yet, folks. So, do yourself and your child a favor and get him vaccinated!

And, thank you again to the Bill and Melinda Gates Foundation for their extraordinary generosity and efforts to help kids!

- Ari Brown, MD, FAAP

WebMD Parenting & Children's Health Newsletter - Must-have children's health news

Food Allergies: What You Need to Know

striatic / CC BY 2.0

Food allergies are on the rise. So, even if you don't have a child with a food allergy, you should be educated about them. It's likely your child will be in a classroom with a food allergic child or invite one to his birthday party. My daughter's last birthday party cake had to be gluten and dairy free (and actually, it wasn't bad!).

So, here's the 411:

Q. What is the #1 food allergy?
A. Cow's milk. While peanut allergy is the top lifelong food allergy, a higher percentage of children are actually allergic to cow's milk.

Q. If a child is allergic to milk, can he have lactose-free milk or Lactaid?
A. No. This is a trick question. People are allergic to the cow's milk PROTEIN. Lactose is the SUGAR found in milk, so lactose-free cow's milk still contains cow's milk protein. Some people have an intolerance to the milk sugar (lactose) which can cause gas and bloating...but a "lactose intolerance" does not cause lip swelling, hives, eczema, or any other serious allergic reaction.

Q. Can a child outgrow a food allergy?
A. Yes. In fact, most children do outgrow food allergies...particularly if they are allergic to cow's milk or soy products. But, people who have peanut or treenut allergies are the least likely to outgrow them.

Martin L / CC BY 2.0

Q. If a child is peanut-allergic, can he have other nuts?
A. Yes. Sorry, this is another trick question! Peanuts are not really nuts. They are legumes. They grow in the soil. Treenuts, like walnuts, pecans, or cashews, grow in trees - hence the name. Peanuts and treenuts are completely different types of allergies. But, there are some food allergies that do go hand in hand. For instance, a person who is allergic to cashews might also be allergic to mangos and pistachios.

Q. How can I make a food allergic friend feel comfortable eating at our home?
A. Prepare foods from scratch so you can guarantee it is okay or purchase prepared foods that list the allergy facts on the label. The good news: with increased demand, even traditional grocery store chains stock cake mixes to make a tasty gluten and dairy free birthday cake!

- Ari Brown, MD, FAAP

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Natural Disasters - Wonders and Worries

This world has seen too much devastation lately. And, it's nearly impossible to keep our kids from seeing or hearing about it. Even if you don't turn on 24 hour cable news when your kids are around, I guarantee they will talk about it on the playground or on the school bus.

It's unsettling enough as an adult, but imagine how a child views a situation like Haiti?! They may wonder if their hometown will be the next place to be struck down by Mother Nature. They don't realize that they have better odds of winning the lottery than having their home destroyed by an earthquake (or hurricane, tornado, tsunami, etc).

But like us, kids like to feel like they are in control of their world. So how do you make a child feel safe while at the same time, admit there are things that are out of their control?

• Explain that some things in life are not predictable and that's okay.


• Give your child a chance to ask you all of his questions and concerns.


• Let a younger child draw a picture to express his feelings. Then talk about it.


• Go over your family plan for emergencies. (If you don't, now is the time to make one!)


• Make a family survival kit (first aid, bottled water, canned food, etc) in case of emergency.


• Have an escape route from your home and a meeting place outside your home, in case of fire. Practice it.


• Make sure your child knows his home address and phone number.


• Tell your child who to contact if he cannot reach you in an emergency.

Bottom line: You want your child to feel like you are prepared for the unexpected and that everything and everyone will be fine if it ever occurs.

The aftermath of destruction in Haiti is also an opportunity to teach your kids about philanthropy. It's a small world, after all. And, we need to pitch in to help each other.

• Let your children participate in making a donation or putting together relief packets (many organizations are accepting basic first aid items, clothing, diapers, canned baby formula, bottled water, etc). Perhaps the easiest way to do it is let them text "Haiti" to 90999 for a $10 donation to the International Response Fund. The fund will send them a nice text "thank you" in response!


• Offer assistance locally. Make it a family project to help those less fortunate in your hometown. Teach your child that people everywhere need help sometimes - not just across the world in a place they've never heard of!

- Ari Brown, MD, FAAP

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Bug O' the Week: Stomach Virus

It's not fun to have any infection, but stomach bugs rank as one of my top least-favorite-germs list. And, the season is upon us.

In honor of David Letterman…I present to you my "Top 10 List of What You Need to Know About the Runs."

10. Don't let the name fool you. Even though people call it the "stomach flu", it is NOT caused by the influenza or "flu" virus. Hence, getting an annual flu shot will not protect someone from this bug. However, there is one vaccine-preventable form of stomach virus (caused by the notorious rotavirus). Since 2005, babies routinely get this vaccine and rotavirus disease has gone way down. Unfortunately, there are still other less serious stomach viruses floating around.

9. The vomiting usually doesn't cause dehydration. The diarrhea does. Vomiting usually heralds the beginning of this illness. But that usually only (only, ha!) lasts for 8-12 hours. It's the 5-7 days of watery diarrhea that can lead to significant dehydration.

8. Don't offer anything to eat or drink while your child is puking…unless you want to see it again. It's just asking for trouble to offer liquids or solids when your child's stomach is unsettled. Wait for at least an hour of being vomit-free before offering small sips of clear fluids. Don't worry, dehydration is not going to set in within the first few hours of illness - so don't push fluids right now.

7. No chugging. Your child will be very thirsty once the initial vomiting is over with. But, don't let him drink as much as he wants to…or it will come right back up. Offer small sips (about a teaspoon of fluid) every 5 minutes to make sure it stays down. Try rehydration solutions like Pedialyte, Rehydralyte, or Gatorade or even ginger ale or good ol' chicken broth.

6. No kissing or sharing food/drinks…unless, of course, you are looking for a rapid weight loss program that involves embracing the porcelain goddess. This virus is spread through saliva and infected poop (a.k.a. the numerous diapers you will change during this illness). Wash hands and don't eat your kid's leftovers.

5. No school with loose poo. Your child is contagious until his poop becomes solid again.

4. Try some good germs. If your child is diagnosed with a stomach virus, you can help get his gut back on track by giving him probiotics. These are the germs that live in the human gut and help digest food. Some common brand names are Culturelle or Florastor. Offer one capsule (pour the powder into food or drink) or one packet a day for the duration of the illness.

3. Milk is okay. Despite what your mother-in-law says, your child can drink milk and eat dairy products while enduring a stomach virus. He's going to have diarrhea no matter what he eats, and dairy is often the mainstay of a child's diet. I only suggest holding off on milk if the diarrhea continues more than 7 days.

2. Pee times three. How do you know if your child is getting dehydrated? Well, he should urinate at least 3 times in a 24 hour period. If he doesn't, check in with his doc.

1. Call if you see blood. Stomach viruses don't usually cause blood in the poop. Your child's doc needs to check out your child (and his poop) if you see blood or mucous in it. It's the glamorous part of our job!

- Ari Brown, MD, FAAP

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BPA - Wake Me Up When It's Over

Friday is the day of the week that organizations like to release stories to the media that are intended to be buried. So, it's not a surprise that the FDA chose a Friday (last week) to announce potential health concerns of a chemical compound called BPA (bisphenol-A). Unfortunately for them, the media was watching.

I've been following this story for a while now, so let me give you the Cliff's notes version in case you've had better things to do than watch the back and forth volley of the BPA saga and our government.

Here goes:

• BPA (bisphenol-A) is a chemical that makes hard, clear plastic (polycarbonate) bottles hard and clear. It is also used in the plastic liners of canned foods (yes, this includes cans of infant formula).


• The health concern is that BPA is an "endocrine-disruptor". In English, it mimics natural hormones made by the body. In this case, the concern is that it imitates the female sex hormone, estradiol. Research done on animals show an association of low levels of BPA exposure to early puberty, breast cancer, attention and developmental problems to name a few. However, we lack human research to prove this risk to us.


• In 2007, a federal independent review panel from the National Toxicology Program/National Institute of Health (NIH) looked at all the existing research on BPA and deemed that there was "some concern" about BPA exposure in fetuses, infants, and young children.


• The reaction to this report? Major stores like Walmart and Babies R Us discontinued selling BPA-containing baby bottles in 2008. In fact, only 10% of the baby bottles on the market today are made with BPA. Despite the NIH report and the market's reaction to it, the FDA stood their ground in 2008 and said BPA was safe.

Now the FDA apparently has had a change of heart. According to the FDA website:

"Recent studies have reported subtle effects of low doses of BPA in laboratory animals. While BPA is not proven to harm children or adults, these newer studies have led federal health officials to express some concern about the safety of BPA... It is clear that the government and scientists and doctors need more research to better understand the potential human health effects of exposure to BPA, especially when it comes to the impact of BPA exposure on young children."

$30 million has been earmarked for NIH research on the health effects of BPA and the study results should be available in a couple of years.

What's a parent to do for the next two years? The FDA has done a nice job of offering tips to reduce your baby/child's BPA exposure. You can get all the details here: Bisphenol A (BPA) Information for Parents.

Is infant formula safe, since the lining may contain BPA? Yes. But, you should know that the liquid formula preparations (ready-to-feed or liquid concentrate) contain plastic liners, and hence, a very small amount of BPA. The powder formula cans do not have detectable levels of BPA. If you use a liquid formula preparation, don't heat the formula up in the can. Pour it into the baby bottle and then heat it.

What about tossing old baby bottles? If you are using hand-me-down baby bottles from your first kiddo, they may contain BPA. Rule of thumb-if it's clear and hard plastic and made before 2008, it probably contains BPA. The FDA says to toss any old bottles that are scratched or worn as that allows more BPA to leach into the liquid in the bottles. My advice: just toss 'em all. Having a baby is expensive (not news, right?) so what's another $50-$75 for new bottles for a little peace of mind?!

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