A major medical controversy is brewing over whether children, age 8 or younger, should be placed on medications to lower their cholesterol.

The reason for this controversy? Heart disease, heart attacks and strokes are now appearing in children in their teens and early twenties. Until now, these diseases that didn’t appear until people were in their forties or older.

So what has changed? Myles Abbott, MD, member of the American Academy of Pediatrics board, asked recently, “We have a tremendous epidemic of obesity (in children), and a lot of these kids now have type 2 diabetes. What is the best way to manage them?”

The underlying problem? Obesity is increasing at an alarming rate in young children, double the rate in the 1960’s, more than three times higher than in the 1990’s, and even higher in some ethnic groups.

Obesity brings elevated cholesterol, high blood pressure, elevated triglycerides, sleep apnea and decreased physical activity. All of these are factors that cause heart and vascular disease. In addition, the fat cells of obesity make the body resistant to insulin, causing type 2 diabetes, a disease of small blood vessels which increases the risk of heart and vascular disease two-fold.

Genetics also play a role in this epidemic. Some families carry the genetic make up for heart disease, some for hypertension and some for dysfunctional handling of blood fats (cholesterol and triglycerides). Some families have the genetics for metabolic syndrome, a combination of all these problems: insulin resistance, obesity, high blood pressure, elevated cholesterol and increased clotting. But not everyone who carries the genes get the disease.

The disease process is triggered by being overweight.

This tends to occur in families even though not all family members may get the disease. Eating habits, exercise and sedentary habits, computer and TV habits are taught in every family by example, from the adults to the children. The family members who stay active, control their diet and do not become obese can avoid the diseases.

For those who embrace the lifestyle habits of their families and friends, and whose genetic makeup allows the disease processes to appear, the result is disaster.

As this epidemic of obesity and disease plays out, some are predicting that these children will be the first generation to have a lower life expectancy than their parents.

What can we do? The American Academy of Pediatrics makes these recommendations:

Screen with blood tests those children with a family history of high cholesterol or early heart disease,
provide nutritional counseling for children (and their parents) with elevated blood fats,
recommend decreased fat milk for children 1-2 years old with family history of heart disease,
use weight management as primary intervention in overweight kids,
consider medications in children over the age of 8 who have high risk for cardiovascular disease.

But how can we prevent this from happening in the first place? What can parents do when they see obesity appearing in their three or four-year-old?

The same preventive strategies work in children that work in adults: increased exercise, decreased fats and simple sugars, weight loss. But in children it is actually easier: a child’s metabolism responds more quickly, and the interventions are carried out by the adults.

How does this work?

Adults control the TV and computers or other gadgets. Never use these electronic devices as babysitters. Limit children’s time with media. Take the children outside and play with them.
Adults buy the food, not the children. Improve your household nutrition. Do not buy or allow foods in the house that are high in sugars and fats. Look on the box; it tells what is in the product. Do not allow others to give your children these kinds of foods.

Result? Children will lose weight and their risk of diabetes and heart disease will drop.

(Oh yes, and so will the adults who are setting the example!)