Bones and joints. Extra pounds put a heavy burden on developing bones and joints. Knees suffer, and obese kids can develop Blount's disease, which is thought to result from pressure on the lower leg that prevents the inner shin bone from developing properly. Often a child will develop bowed legs. Hip joints suffer, too, and weight may cause the head of the femur in the hip joint to fracture, explains Hassink. The treatment requires a pin or screw to be inserted for support.
Menstrual cycle. Girls who are obese may get their first period earlier than is typical. Population studies have suggested that such early-onset menstration is a risk factor for breast cancer, Jacobson says. The mean age of onset in the United States, he says, is 12.5 years of age, but "with overweight girls it is significantly earlier—it might be a year or so." Later on, obese women may develop irregular or stopped periods, more acne, and excessive hair growth as a result of polycystic ovarian syndrome. This, of course, becomes a problem as they grow up and want to have children, Hassink says.
But parents and obese children alike need not feel overwhelmed or powerless. "I've seen many, many kids do very well in managing this problem," says Jacobson. Yes, it takes concerted effort—not only on the part of the child, but also on the part of parents and siblings. A supportive household is essential, as is a real hard look at the family's nutritional and activity habits.
One common struggle occurs in families with one obese or overweight child among others who are picky eaters and skinny. Parents often believe that ice cream, cookies, and sugary beverages are necessary to get the slender kids interested in food. "That's a fallacy," Jacobson says, since "picky eaters who happen to be slim need the same five servings of fruit and vegetables, lean meats, and low-fat dairy." Another challenge for parents is the busy factor. Meals may not get made ahead of time, which means relying too heavily on the fallback takeout or microwavable dinners. "The literature is pretty good at showing the number of restaurant and takeout meals [a child eats] is pretty well correlated with a child's body mass index," says Jacobson.
Of course, a big part of the problem is that recess during school is not a given like it used to be, and children spend more time riding in cars than riding their bikes. It falls to parents to turn off the television set and move the fun outdoors. One effort worth making: rallying neighborhood parents. "The average child wants to exercise," Hassink explains. "What gets them there is play with other kids."