Helping to defeat Generation O

Cayman Heart Fund’s Heart Health Fair brought to light some alarming news with regard to the state of health of Cayman’s children, with the finding that a disproportionate amount of children appear obese in Cayman, verses the US (a country that is itself battling astronomical obesity rates.) Business Editor, Lindsey Turnbull finds out what plans are in the pipeline to remedy this current state and reports.

Cardiovascular disease accounted for 29.2 per cent of deaths (16.7 million people) in the world in 2003. Risk factors are hypertension, high cholesterol, type two diabetes, smoking and obesity. When children become obese, they are setting themselves up for a (no doubt shortened) lifetime of serious conditions and diseases, such as CVD, but obesity is, in most cases, preventable.

Pediatrician specialising in childhood obesity Dr Pedro Reimon, from Miami’s Pediatric Weight Management Associates, visited Grand Cayman earlier this year to take part in Cayman Heart Fund’s symposium, updating Cayman’s medical community on the latest initiatives to beat CVD, and he also attended its Heart Health Fair to educate Cayman’s public on the dangers of obesity in children. He also toured a public and private school in Cayman, to get a first hand look at the weight issues facing Cayman’s young people.

This is his observation: “It is with great concern that I write today about my recent trip to Grand Cayman. I first want to thank Baptist Hospital, the physicians, and all the people that made me feel so welcomed while I was there. I was told before I arrived in Grand Cayman that the incidence of childhood obesity was worse than in the United States, but I did not expect to see what I did. I visited two schools, the first school was private, and the second school was public. After visiting both schools, here are some of my concerns.

The private school offers physical education only twice a week. I saw the heavier kids sitting around not exercising, and the kids that had a healthy weight running around being physically active. I was told that they also engage in after school activities. We have to make sure that those kids that really need the exercise are not choosing to get involved in sedentary choices such as art and music. The percentage of overweight-obesity in this school to the best of my observation was similar to the United States, about 30-35per cent.

The public school was a complete shock. I saw easily 60-70 per cent of the students being overweight or obese, but the biggest concern is the amount of adolescents suffering from morbid obesity. I was able to walk through the cafeteria and again I was shocked to find that the first foods that the kids see are chocolate bars and fruit juices. It also did not help that it was pizza day. Another big concern is having a Burger King and Wendy’s right besides the school.

As we all know childhood obesity is a global crisis that affects our most treasured gifts, our children. We need to find a way to work together to be able to beat this terrible disease, and the complications that it brings. I believe that together we can change the future; and we can see our children and grandchildren grow and become healthy adults.”

Dr. Sook Yin, medical director of the Cayman Heart Fund gives her comments on the situation in Cayman: “We are extremely concerned about the obesity rate of the children in Cayman, so one of our main priorities this year when organising the cardiac symposium was to invite a specialist in pediatric obesity to make some general observations in our community regarding overweight children and also to address the medical community as how to work together with the parents and the schools to start combating this problem.

Reimon rightly pointed out that we must first recognise that we have a problem here and that we have to overcome some cultural habits and upbringing. Many cultures tend to overfeed toddlers and even when they start shaking their heads and plainly refusing food, they are forced to finish that last few spoonfuls, as many people perceive that chubby toddlers mean healthy toddlers. That we know is not the case.

Parents need to set a better example in their own eating habits and a play a more active role in encouraging their children to be more physically active. After all, the children are dependent on their parents to buy and cook the food so we as parents need to make the right choice in food and also monitor the portions that we give our children. Bad habits at a young age are harder to undo, but it is not impossible with the right intervention.

School canteens have a role to play as well in providing healthy choices and stopping the sale of high sugar and high fat snacks, but they are also dependent on the support and the co-operation from the parents to enforce good eating habits during home meals so that the message is consistent. It is all about behaviour modification.”

The findings

Dr Yin reports: “This year Cayman Heart Fund partnered with Rotary Sunrise for their Heart Health Fair 2009 to have an even larger corner to promote heart health in children. There were lots of prizes to be won and a host of activities to occupy the children in attendance (the interactive Wii booth was popular). Parents were able to obtain information on dietary requirements for growing children and healthcare professionals and paediatricians were on hand to give advice. This also gave us the perfect opportunity to obtain real data on obesity rates and how blood pressure in overweight children is becoming a bigger problem and often go unnoticed if they are not screened.

With the help of volunteer nurses and nutritionists we were able to screen the children attending the Fair. We screened 102 children and the average age of this group was 8.5 years. Children’s weights are categorised into ranges of percentiles to show whether they are underweight, normal weight, overweight or obese. For example the overweight group is between the 85th and 94th percentile and obese category is over the 95th percentile. We found that 24 per cent were obese, 13 per cent were overweight, so combining these numbers, the total percentage of children who were overweight was 37 per cent. This is comparable to North American statistics and also comparable to the obese group of Cayman students at school entry (4-6 years old) in September 2008. (That figure was 22 per cent but no figures were available at middle or high school level.)

We also measured the blood pressure of these children and found that of the overweight and obese group, 33 per cent has a systolic pressure of over the 75th percentile and 44 per cent of the same group also has a diastolic pressure of over 75th percentile. Of note, the children of normal weight had normal blood pressure readings. 

The cure

Dr Yin says: “Reducing the obesity rate in children in Cayman can’t happen in isolation; it will require the government’s help in reducing duties on nutritious food, such as vegetables, fruit, dairy products and wholegrain products, to lower the price so that the public can afford and be encouraged to eat them.

Banning transfats in all restaurants and fast food chains will be another avenue that government can take.

The education system needs to incorporate more compulsory physical education into their curriculum (once or twice a week is simply not enough) and have a more varied and fun after school activity programme targeted at those who are not training in traditional sports. Supermarkets could help by displaying easy-to-read calorie, sugar and fat contents of the different food groups and encourage consumers to eat healthier foods to maintain a healthy weight. School canteens should work with nutritionists and PTAs to develop a proper menu for nutritious school lunches and snacks.

Sugary drinks, especially sodas, have no place in a school canteen. Having a Weight Management Programme for overweight children with a multidisciplinary team approach will be a good way to kick-start this campaign and it will require the whole community to support this.

The findings are alarming and something has to be done about it before this generation of overweight children grows up to be a generation of unhealthy adults with multiple chronic health issues that will burden the health system further.

Baptist Health is planning to create a weight management programme for young people in the Cayman Islands that will encompass the three major areas necessary if the plan is to succeed, i.e. nutrition, physical activity and behaviour modification.

Reimon anticipates assembling a core team of specialists, including a paediatrician who specialises in childhood obesity, dieticians and a psychologist, who will work together on this much-needed programme.

Reimon says, “In particular, we are targeting young people between the ages of 5 and 18. They will engage in a six month basic programme followed by a maintenance phase that will ensure that all the good work is properly maintained.”

It is anticipated that the centre will spearhead initiatives targeting the public and private schools. Reimon says, “Identifying which children are overweight early will be a key goal.”

Extending the programme out further, Reimon says a hospital prenatal prevention programme could be initiated. “It’s essential to get everyone involved,” he says. “And to ensure that funding is found to help those people who cannot afford the programme.”

Healthwatch-group

From left to right: Diane Montoya (permanent secretary of ministry of health and human services), Dr. Greg Hoeksema (CMO of HSA), Dr. Shirley Cridland (Children’s Medical Director of CHF), Dr. Sreenathan (Dean of Student affairs of SMU), Dr. Senthil Kumar (Dean of Basic science SMU), Dr. Robert Canby (Consultant electrophysiologist of Texas Arrhythmia), Dr. Pedro Reimon (Consultant of paediatric obesity), Charmaine Moss (Secretary of CHF), Suzy Soto (Chair person of CHF), Dr. Sook Yin (Medical Director of CHF), Velrose Vaughan-Morrison (Rep of Astra-Zeneca), Dr. Howard Bush (Consultant Cardiologist Cleveland Clinic), Dr Lou Cona (CME coordinator of CIMDS), Dr Voght- Lowell (Consultant paediatrician Baptist Health) and Kevin Doyle (Vice Chairman CHF)

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