Sixteen-year-old Loveline Bédard, who was born with a brain tumour, moved to Montreal from her native Haiti at age 5.
The treatment she received here to shrink the tumour included high doses of a corticosteroid, which, among other things, caused fluid retention and insomnia, and made her constantly hungry. And no matter how much she ate, she didn’t feel full.
“Every night, I would wake up and eat a plate of fruit and a plate of cookies that my mother prepared for me. I ate everything. I ate a lot at night. During the day, I ate huge portions,” Bédard said.
By the time she was 6 years old, she had experienced such a rapid weight gain that she had trouble walking.
Whether as a result of a medical condition or just the consequences of calorie-rich diets combined with reduced physical activity, obesity rates among young people are rising around the world and across all socioeconomic groups.
The most recent Canadian Health Measures Survey, using data from 2009-2011, found that 31.5 per cent of children age 5 to 17 are overweight (19.8 per cent) or obese (11.7 per cent).
It’s a phenomenon that Dr. Ana Sant’Anna, a pediatric gastroenterologist at the Montreal Children’s Hospital, has observed while doing her rounds — more and more of her young patients are overweight.
In 2012, in an effort to better understand the extent of the phenomenon, Sant’Anna conducted a study on 277 patients in the Children’s clinical and surgical wards, ranging in age from one month to 17 years.
Sant’Anna, a specialist in nutrition, was shocked by the results: 13 per cent of patients were underweight, and 21.2 per cent — more than one in five — were overweight. That 21.2 per cent could be divided into overweight (12.6 per cent), obese (6.1 per cent) and severely obese (2.5 per cent).
For years, health care professionals have warned us about the empty calories in processed foods and the consequences of a sedentary lifestyle. Never before has there been such an abundance of food choices — yet many of us eat processed foods that contained little of the nutrients and minerals required to healthily fuel our bodies. And processed foods are rife with sugar, salt and fat.
The result is a twisted paradox: We are overweight and undernourished.
Cooking is a bit of a lost art but it needs to come back because I think we eat a lot healthier when we prepare our own food.
Dr. Laurent Legault, a pediatric endocrinologist at the Montreal Children’s, put the situation in a historical context. “Our metabolisms have been hardwired to sustain famine,” he explained in an email. “We are witnessing in the last 30 years a shift (whereby) food is abundant. Fatty and sweet foods are available at affordable prices and in large quantities.”
And, Legault cautioned, if you think someone who is plump during childhood will simply outgrow it, think again. “If a child is obese during their teens, the risk of carrying that extra weight as an adult is at least 75 per cent.”
Dr. Mélanie Henderson, pediatric endocrinologist at Montreal’s Ste-Justine Hospital, points to certain problematic trends that contribute to packing on the pounds. She cited the U.S. documentary Super Size Me, which highlighted the “super-size” portions at the McDonald’s fast-food chain.
“We need to go back to moderation,” Henderson said. “We have a lot of processed foods. … Cooking is a bit of a lost art but it needs to come back because I think we eat a lot healthier when we prepare our own food.
“I think we’re just now beginning to understand the complexity of all the factors that come into play,” Henderson added. “Children are not meeting current guidelines for physical activity, and are engaging more and more in sedentary behaviours such as TV and video games.
“There’s more evidence that sleep is an important risk factor. We know today that kids sleep an hour less than they did 20 years ago. So there are a lot of factors but most of them are interconnected.”
And the earlier children become obese, the longer they accumulate the condition’s detrimental effects, Henderson said. There is some evidence to say that obese children today will not outlive their parents’ life expectancy.
Ramifications previously observed in overweight adults are now manifesting in younger people: dyslipidemia or abnormal cholesterol, joint problems, pre-diabetes, hypertension, type 2 diabetes, insulin resistance, cardiovascular disease, and certain hepatic complications or fatty liver complications. Fat deposits in the liver cause inflammation that can devolve to cirrhosis if not addressed.
One of the driving forces in the battle against childhood obesity in Quebec is the Ste-Justine Hospital’s Centre d’Intervention en prévention et en Réadaptation CardiovascUlaIres pour Toute la famille, or Centre CIRCUIT.
Created in 2011 and currently serving 220 patients, the centre’s objective is to not only prevent obesity, but rehabilitate children who are at risk for cardiovascular disease through personalized intervention strategies.
And for Bédard, it’s made all the difference.
Before participating in CIRCUIT’s program, Bédard thought she had to exercise to the point of exhaustion to lose weight, but has since learned that what’s important is to start moving — and to keep moving.
New patients at CIRCUIT fill out a questionnaire on their lifestyle habits, including screen time and other sedentary behaviours. A kinesiologist, a professional in human movement, evaluates the child’s cardiovascular health, fitness, motor skills, flexibility, endurance and strength, explained Henderson, who is also co-director of the centre.
Patients return home with an accelerometer, an instrument that measures movement, a GPS and a heart monitor. Data from these instruments provide a general health and activity profile.
“The idea is to map out in their environment where they’re physically active, where they’re most intensively active, and what opportunities are missed,” Henderson said. The information is analyzed and a comprehensive plan to increase physical activity is developed.
“I’ve lost a lot of the weight and I feel better,” said Bédard, who has been visiting the centre for two years. “I’m doing everything to make sure I don’t regain what I’ve lost.”
Kids who are overweight or obese tend to be victims of intimidation and of mockery, so they’re not the kids who are necessarily going to go after the soccer ball and try to score a goal because they’re self-conscious.
Frequently, Bédard deals with more than just the challenges of losing weight — she is subjected to derogatory comments about her body when playing sports with her peers.
“I do a lot of sports but sometimes I find it hard because of my friends and my entourage,” she said. “There’s a lot of teasing. Sometimes jokes turn out bad and they mock my weight.”
None of this surprised Henderson. “Kids who are overweight or obese tend to be victims of intimidation and of mockery, so they’re not the kids who are necessarily going to go after the soccer ball and try to score a goal because they’re self-conscious.”
For the last two years, Bédard has also attended SNAP (which stands for: santé, nutrition, activité physique), a summer camp in the Laurentians for children age 8 to 16 who are overweight or obese. The camp is sponsored by CIRCUIT and the Centre Père Sablon sports complex in the Plateau-Mont-Royal.
Campers learn about nutrition, portion size, and get hands-on experience in preparing and cooking food.
Sometimes what people say about my weight bothers me, but then I get myself back on track.
Henderson stresses that SNAP is neither a boot camp nor a weight-loss camp — it’s about establishing healthy habits among young people. “We believe that nurturing healthy lifestyle habits early on in life is probably the best way to prevent cardiovascular disease, obesity, type 2 diabetes and all its complications.”
Campers learn about themselves through sports and wellness workshops discuss the issues surrounding obesity: victimization, bullying and body image. “We try to touch all the spheres that we think are important in these kids’ lives,” says Henderson.
Despite regularly experiencing fatigue from the radiation therapy that manages her tumour — which has stopped growing but continues to impair her vision — Bédard’s determination to be healthy remains steadfast.
“CIRCUIT has helped me feel strong and confident that I can achieve my objective. Sometimes what people say about my weight bothers me, but then I get myself back on track.”
Bédard hopes to one day open a restaurant featuring international foods — all healthy, of course.
For her part, Henderson is staunchly positive about battling obesity. “On every level there’s a role for society to play. In schools, physical education is a lost part of the curriculum. Have you ever seen a TV commercial for healthy food? We need to address this in a positive light, so rather than say, ‘Oh, my God, we’re never going to make it,’ say, ‘Look at all the opportunities we have to make change.’ “
The Public Health Agency of Canada suggests that children age 5 to 18 do at least one hour of moderate to vigorous physical activity per day, with a maximum sedentary time (watching TV, playing video games, social media, etc.) of two hours per day.
A WORLDWIDE PROBLEM
Once considered a high-income-country problem, obesity is on the rise in low- and middle-income countries, particularly in urban settings. According to the World Health Organization, in 2013 the number of overweight children below age 5 exceeds 42 million — approximately 31 million of whom live in developing countries. The WHO also states that most of the world’s population live in countries where being overweight and obese kills more people than being underweight.