Nutrition, obesity and perception
Focusing on America's children

-- A spate of recent medical studies points to Americans' fears and concerns regarding obesity and diet - both real and imagined

Five studies focused on a variety of obesity-related issues, including unnatural body image expectations among girls as young as 5 and the effects of actual obesity on children's health. All are published in this month's issue of the journal Pediatrics.

The reports surface even as concern grows over the number of overweight youngsters -- 25 percent and rising, by some estimates.

Even very young children are aware of society's fixation on thinness, according to a study from Penn State University. Researchers found that lowered self-esteem was associated with being overweight in girls as young as 5. This attitude was closely correlated with parents' perceptions.

"Don't tease girls about their weight, even in a gentle way," Dr. Leann Birch, head of the university's department of human development and family studies and a study co-author, advised in a statement. "It's clear from our study that the notion that one's weight can be a social liability emerges early on."

Another study from Brigham and Women's Hospital in Boston, Massachusetts, also concluded that weight concerns were found even in children of normal weight.

"Girls have been encouraged to form unrealistically thin body ideals" by the mass media, said study leader Alison Field. A similar view of the buff male physique "is taking its toll on boys, making them more susceptible to being overly concerned about their weight," she said.

Fewer than one-third of programs that train pediatricians in the United States consider the negative effect the media can have on children's health, according to a survey of residency programs.

"Just as pediatricians have included health risk avoidance using nonmedical tools such as bicycle helmets and seat belts, media effects need to be included as part of the health maintenance visit," said study authors Dr. Michael Rich of the Harvard Medical School and Dr. Miriam Bar-on of Loyola University.

Along with unrealistic ideas about weight, however, runs a concurrent finding that children's health is being undermined by the reality of obesity and poor nutrition habits.

A study from the School of Nutrition, Science and Policy at Tufts University in Medford, Massachusetts, found that children whose families routinely watched television at mealtime ate more salty snacks and sodas and fewer fruits and vegetables than those who turned the TV off while eating. The Tufts study suggests that advertising and programming provide unrealistic ideas about normal diet. Parental education also is a factor, Rich and Bar-on found.

When obesity does come into play, preliminary evidence suggests that the condition can have adverse health effects even early in life.

Studying U.S. children aged 8 to 16, Epidemiologist Marjolein Visser of Vrije University in Amsterdam, Netherlands, discovered that even the youngest overweight children had a bloodstream inflammation that has been linked to heart disease in adults. The overweight children in Visser's study were three to five times more likely than those of normal weight to have such inflammation, which associated with a marker called C-reactive protein, or CRP.

The Amsterdam work is the first to link childhood obesity with heart disease, and could help to explain why people who were overweight as children still run a higher risk of cardiovascular disease and diabetes after they become adults, even if they've lost weight.

"When we can start documenting the physical changes occurring at that age, it's just like a time bomb just below the surface of their skin that's going to go off someday," Dr. Michael Steelman, past president of the American Society of Bariatric Physicians, told The Associated Press. Bariatrics is a specialty devoted to the study of obesity.

Visser's study does not address long-term or short-term health risks in children, but previous research has linked elevated levels of CRP in overweight adults with heart disease. Increased CRP levels may indicate arterial inflammation from the early stages of heart disease, according to some studies.

Elevated white blood cell counts, another sign of inflammation, also were more common in overweight children.

Visser worked with the U.S. National Institute on Aging for the study.

The five studies involved 15,906 individuals and a survey of 204 pediatrics residency programs.