Weighing In On Keiki Obesity

Dr. Vince Yamashiroya
Pediatrician
Interviewed by Melissa Moniz

What are the most common ailments children come in for?

For pediatricians, it’s mainly ear infections, colds, rashes and allergic diseases such as asthma, eczema and allergic rhinitis.

Is there anything going around right now?

Yes, there is. Last week we did see a lot of stomach flus, and saw a lot of kids with vomiting and diarrhea. And I’ve also recently seen many kids with regular colds.

What is the Hawaii Pediatric Weight Management Toolkit?

This is a toolkit for managing overweight children, which was the idea of Dr. Galen Chock. A group of parents and pediatricians had input on the construction of this toolkit. This has many useful tools, such as parent questionnaires, tips on how to lose weight and other educational materials. This was presented at a meeting Nov. 8, 2007, and many pediatricians showed up - maybe about 150 or so. What was presented at this meeting is that obesity is a really big epidemic. For example, in the 6- to 11-year age group, 20 years ago only 5 percent was considered overweight, but now in 2003 and 2004, 20 percent of children are overweight.

Have you been using the toolkit with your patients?

I have, but it’s difficult because it takes time, and unfortunately insurance companies won’t pay for an obesity visit. So I try to incorporate it when I see children for their well-child visits. The problem using the toolkit with the well-child visits is they don’t come every year, and only come for sports physicals or for private school physicals. So it is tough, but I spend a few minutes to go over it. We are all trying to learn tricks to educate our patients about diet and exercise. The first thing is identification. They have to know that they are overweight. Then the second thing is if they want to lose weight. Sometimes I show them the growth curves and the parent will say, “I’m not too worried about it.” So you know they’re not going to do anything about it.

How is obesity in children defined?

For obesity, we look at the body mass index, which is calculated by using the weight and the height. If someone is between the 85 and 97 percentile for their body mass index, then they are considered at risk for being overweight. If they are over the 97 percentile, then they are overweight.

Obesity is looked at as a combination of genetics, diet and exercise. Of those three factors, what do you think is the biggest denominator?

I would say genetics is a big one. But diet and exercise do play a big role, too. The good thing about kids is, if you catch it early, then they don’t need to lose weight, they just need to maintain their weight because they are still growing taller.

From what age do you start looking at obesity as a problem?

Usually I would say after age 2, but even before age 2 there are things that you can do to educate parents to make sure their child is not gaining too much weight. Pediatricians were mailed handouts a couple of years ago, which are healthy tips starting from 12 months of age.

There are some parents who are opposed to getting their children immunized. Can you talk about that?

I think that the anti-vaccine movement seems to have been popularized by parents with autistic children. Autism is defined as a delay or abnormal functioning before 3 years of age in at least one of the following three areas: social interaction, language, and symbolic or imaginative play. Unfortunately, we don’t know what the cause of autism is. One of the possible causes of autism was thought to be due to immunizations, specifically thimerosal. Thimerosal is ethyl mercury and a preservative found in vaccines. We do know that high doses of methyl mercury, which is found in fish, can potentially damage the developing brain. Also a few years ago, the MMR vaccine also was linked to autism in a European study. Because of this, some parents have been wary about immunizations. Research has shown that there is no link between autism and thimerosal, but as a precaution, vaccine manufacturers have taken it out of most of the vaccines. Sadly, some states have actually banned thimerosal in the vaccines. Despite this, autism rates are still increasing in those states. Further research has also disproved the link between MMR and autism.

What are some tips parents should follow to keep their children healthy?

Eating healthy, exercising. Use sunscreen; wear sunglasses and a hat. Use a car seat, booster seat and seat belt. Breast-feed your babies for at least a year. Vaccinate your children against life threatening diseases. Love your child fully, discipline your child early and do not fill your child’s day with too many activities.

This information is provided as educational and is not intended as a substitute for consultation with a physician. For questions, consult your physician or call the Honolulu County Medical Society, of which Dr. Vince Yamashiroya is a member, at 536-6988.

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