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Children Setting Table for Heart Disease

Heart doctors urge change in habits now to prevent disease later

MONDAY, July 1, 2002 (HealthDayNews) -- America's cardiologists are looking at the country's children, and they don't like what they see: a bunch of overfed, under-exercised young people who are setting themselves up for cardiovascular trouble later in life.

The American Heart Association is publishing cardiovascular guidelines for children in tomorrow's issue of Circulation, recommending the same sort of lifestyle measures that are standard for adults -- no smoking, healthy eating, physical activity -- and that are too often being ignored by young people.

One starting point is an epidemic of obesity, which has doubled in young people over the past two decades, with the highest rates among black and Latino youths. Another is the observation that 20 percent of adolescents smoke daily by the time they are high school seniors. A third is an inclination to spend spare time watching television or playing video games rather than engaging in physical activity.

"We must act now or these overweight young people could be at risk of developing heart disease at a younger age than their parents' generation has," says a statement by Dr. Christine L. Williams, director of the Children's Cardiovascular Health Center at Columbia University's Babies and Children's Hospital.

"The earlier one gets into preventive behaviors that can make a difference, the better off the whole population will be," says Dr. Hugh G. Allen, a spokesman for the heart association.

Parents should be looking at what their children eat, Allen says, because "young people generally are allowed to choose their diet, and what they often choose is greasy, fatty, junk foods."

Ideally, Williams says, parents should help children visualize a "healthy plate," one half-filled with salads and vegetables, a quarter with potatoes, rice, or similar carbohydrates, and only a quarter with protein -- with fish, poultry, or soy as protein dishes, along with the inevitable burgers or other meats.

Too often, Allen says, parents use food as a reward for good behavior. "Making exercise the award would be better," he says.

Suburban dependence on the auto means that "walking is nowhere near as common as it was when I was a child," Allen says, although he sees a bright spot in the trend to such healthy activities as playing soccer. "I still think shutting off the TV, spending less time on video games, and making physical activity a reward should be done," he says.

As for smoking, the obvious starting point is for parents to stop. "Many children are, in effect, already smoking on a regular basis by breathing the residual smoke from cigarettes lit and inhaled by their parents," says the heart association statement.

Some young people smoke because they think it will help keep them thin, others because their friends do. Parents can do a job of education on both counts, telling children that the harm done by smoking outweighs any benefit. "Learning to say no to peer pressure is critical," Williams says.

Concern about early development of cardiovascular disease is not new, Allen says. It dates back at least to the early 1950s, when autopsies on Korean war casualties showed that many had significant blockage of the arteries. Encouraging healthy behavior by young people is especially important when there is a family history of heart disease, he says.

"That is a huge red flag," he says. "Every time I see that a family member has had an early heart attack -- and even age 50 is early -- I place more emphasis on prevention."

What parents do is much more important than what they tell their children, says Dr. Steven B. Heymsfield, a professor of medicine at Columbia and director of the obseity research center at St. Luke's-Roosevelt Hospital.

"What we have to do is attack the environmental factors leading to obesity, and for a child the environment encompasses the home," he says. "Often the parents are overweight, contributing behavior or genes that lead to obesity, so it is a family problem. To help a child lose weight, we have to attempt to restructure the environment in a way that makes it easy for a child to adopt good behaviors. But there is a lot of sensitivity there. You don't want to make a child overly self-conscious."

Sometimes the source of the problem is plain to anyone who looks, Heymsfield says. "How many times do you walk down the street and see a very overweight parent standing next to an overweight child?" he asks.

What To Do

The American Heart Association offers information on obesity and on physical activity.

SOURCES: Hugh G. Allen, M.D., physician in chief, Children's Hospital, Columbus, Ohio; Steven B. Heymsfield, M.D., professor of medicine, Columbia University, New York; July 2, 2002, Circulation: Journal of the American Heart Association
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