Stanford designing anti-obesity program for kids

$12.7 million federal grant lets researchers 'start from scratch' with behavioral, environmental approaches

The Stanford University School of Medicine has won $12.7 million in federal funds to design a new approach to battling childhood obesity that could be used across the country.

The grant will allow researchers to test a behavioral and environmental approach to childhood weight control –- using soccer teams and dance classes, for example -– rather than a traditional medical model.

The funds are part of the National Institutes of Health's $49.5 million Childhood Obesity Prevention and Treatment Program, with other grants going to Case Western Reserve University, the University of Minnesota and Vanderbilt University.

"Traditional medical care doesn't address obesity particularly well," said Thomas Robinson, professor of child health, pediatrics and medicine at the medical school.

"It's geared toward the medical aspects of the problem, not its behavioral or environmental components. This grant is an opportunity to say, 'What if we start from scratch with a new model?

"'How would we build a treatment program that uses existing resources in the medical care system, the community and families to approach childhood obesity?'"

Robinson directs the Center for Healthy Weight at Lucile Packard Children's Hospital. Its intensive, six-month pediatric weight-control program has resulted in success for 80 percent of participants, according to officials.

"Our study will test a very exciting new model for treating overweight and obese kids," Robinson said. "Currently, most communities have few resources to help these children and their families."

The study will incorporate strategies developed in some of Robinson's previous research on ways to make weight control fun. For instance, overweight children enjoy and benefit from soccer teams and dance classes organized just for them, his team has found, even if they feel too self-conscious to participate in physical activities with normal-weight peers.

"We've found that kids are intrinsically motivated to adopt healthful behaviors when the change is fun, gives them a sense of choice and control and provides challenges and a sense of accomplishment," Robinson said. "We're building upon those findings for our new program."

In the new study, overweight and obese children will get diagnostic evaluations and medical attention from their existing primary care providers; learn healthy eating and exercise habits in specially designed community after-school programs; and receive home visits to make their living spaces conducive to weight loss. After two years of development and pilot tests, the researchers will test the program with 240 obese 7- to 12-year-olds and their families. Each family will receive treatment for three years. Half will receive the new treatment program; the remaining participants will receive standard-of-care treatment plus an after-school program. The analysis will include evaluation of the program's cost-effectiveness. It will be one of the longest and largest studies ever conducted on childhood obesity treatment.

"It's a really unusual opportunity to receive this much funding and time to develop and test a new model of care," Robinson said. "We're very excited that we will get to extend the capabilities of primary care professionals, leverage community resource and provide individualized family- and home-based services where kids live."

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Posted by Been There Done That
a resident of Another Palo Alto neighborhood
on Sep 20, 2010 at 10:29 am

Children learn what they live. I think very few children magically put on weight without having over consumption of everything modeled in our culture. Quite often one or both of the parents are obese as well. This is a family and cultural disease. I remember growing up in the 60's where there was a resurgence of interest in physical fitness during the Kennedy administration. I think there was an Air Force program of exercises that my family started doing together. Unfortunately, smoking was very prevalent then and I took up smoking much too early (quit for many years now). I think the general lack of movement that is systemic in our culture is highly related to technological things from TV to video games, to texting, to surfing the web instead of the Pacific. It just goes on and on. We need to have a complete overhaul in our way of thinking and behaving in order to change this situation. As Michael Moore said in today's news, Mc Donald's has caused many more deaths than the Ground Zero events. Yes, fast food is doing a heck of a lot for creating fat kids and often the parents are too poor, too lazy, too uneducated, or too stressed to prepare healthy food. It can be cheaper but requires effort and time to create. All this seems like a no brainer though.

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Posted by Sara
a resident of Barron Park
on Sep 20, 2010 at 11:25 am

I believe the prevelance of snack foods and the amount of snacking by children is contributing to obesity in a huge manner. There is a lot of anecdotal observations about snack food, but I believe the number of times per day that a child is eating needs to be looked at. It seems children don't go anywhere today without mom or dad taking tons of snacks with them as if the child will starve if they don't eat two hand fulls of goldfish crackers. I don't think we allow children to ever get hungry. This is a set up for a food addiction. If we can prevent the snacking habit before it starts, we might win half the battle.

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Posted by Felicity
a resident of Los Altos
on Sep 20, 2010 at 11:32 am

I never thought I would have an overweight child. Ivy educated, active slender parents do not necessarily make for identical kids. My older son is thin, the younger overweight. He was skinny until he turned 8 and then he started to eat to feel better. A child of divorce with a handsome overachieving older brother, food made him feel better. TV is a solace and the computer is his connection. Only healthy food is in the house but that doesn't mean that crackers, peanut butter, etc. don't add on the calories. And once they are able to carry change and find a machine.... I am not too worried as I went through a period like that from 10 to 14 as a child looking for something to fill a hole of sorrow (formed by an artistic temperament in an academic school; my parents were great) until I was able to find wholeness within. I hope this study can help with the emotional component of eating which is probably why the vast majority of attempts to lose weight fail. So, don't be so quick to judge that all overweight kids are from MacDonald's eating, don't know how to exercise, fat parents.

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Posted by Right on!
a resident of South of Midtown
on Sep 20, 2010 at 11:38 am

Walking, biking...getting out for fresh air is GOOD for kids...and their parents. (We ALL need daily exercise.) Our community is fabulous for walking and biking. We have beautiful weather, flat terrain, shaded sidewalks, well-designed bike lanes. There is no need to spend so much time sitting in the car driving EVERYWHERE. Try it. You'll discover that, for many of your local trips, biking is FASTER.

What's good for our bodies, in this case, is also good for our planet. We need more communities designed to be friendly to bicyclists and pedestrians.

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Posted by palo alto mom
a resident of Duveneck/St. Francis
on Sep 20, 2010 at 11:53 am

Felicity - thanks for bringing up the issue of emotional eating, and that healthy foods have calories too. Similar issue in our house, active, healthy weight parents, slim siblings, overweight child who eats (things we need for everyone like turkey, peanut butter, etc.) for emotional reasons... things are improving and the good thing about kids is that they grow. Our child has stopped emotional snacking for the most part and is growing into his weight.

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Posted by Resident
a resident of Another Palo Alto neighborhood
on Sep 20, 2010 at 12:00 pm

Several posters have made a lot of sense here. Snacking, low self esteem, availability of junk food, fewer opportunities for teens to play school sport, are among the contributing factors. Palo Altans are generally well educated on what we should eat and feed our kids, but sports snacks, pizza parties as prizes, ice cream socials or pancake breakfasts as fundraisers still occur all the time.

Our culture has to change. It can't be done by families alone, or schools alone, but there has to be a move to stop feeding our kids when they don't need it. Of course a child is not going to eat a salad/veggie/whole wheat bread sandwich for a healthy lunch when they know that in an hour or so they are going to be given some junk food at their next activity!

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Posted by It's learned behavior
a resident of South of Midtown
on Sep 20, 2010 at 1:18 pm

One place to start is with our LIBRARIES. They publicize events for children and entice them with unnecessary rewards of junk food -- pizza and sugary cookies and snacks.
This kind of eating is learned behavior and our libraries are doing a bad job, training children in unhealthy eating.
Maybe the librarians need to read Dr David Kessler's book about how our brains are triggered to want sugar, fat, and salt. And stop reinforcing unhealthy behavior.

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Posted by Vianica
a resident of Palo Verde
on Sep 20, 2010 at 1:51 pm

So much money to a bunch of people (who may or may not have kids)to figure out what should be a common sensical everyday family approach! It's ridiculous. Unless families take the initiative to put the right stuff on the dinner plates(does not have to cost a ton for that) take active interest in their own lives and that of their kids, obesity is not going to magically disappear no matter how much money is spent on such nonsensical research!

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Posted by susan
a resident of Menlo Park
on Sep 20, 2010 at 2:40 pm

I recently found out that my 12-year old niece, who lives in Oregon, has been diagnosed with a heriditary condition that has been causing her to gain weight. She had been getting home taught for the last year because she was teased at school. I think this is one good reason that this study is going to be going on here - on the off-chance that a % of children may have a medical condition.

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Posted by palo alto resident
a resident of Meadow Park
on Sep 20, 2010 at 3:42 pm

I think there is something fundamentally wrong with how we live today, and what we transmit to our kids. The kids are cooped up in the house, if they want to play with a peer - the parents have to have a play appointment for them, they are not allowed to be on the block (street) and "talk to strangers". Many of their activities are cerebral and they don't move their bodies. Out of boredom and lack of meaning, freedom and sponteity - they eat. One walks on the streets of Palo Alto and does not see kids playing outside, interracting with each other, forming neigborhood communities. Every thing is structured for them and very controlled. I pity them. Food, which is available and pleasurable, becomes a good friend, and this friendship is taken to the extreme.

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Posted by TheThinMan
a resident of Stanford
on Sep 20, 2010 at 4:25 pm

This is a timely study, as today there have been reports about a smallish study (n=124) by UCSD researchers which is to appear in the journal Pediatrics. They found a possible link between the presence of a virus -- adenovirus 36 (AD36)-- and childhood obesity. Larger studies need to be done to confirm this.

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Posted by It's learned behavior
a resident of South of Midtown
on Sep 20, 2010 at 4:45 pm

If they find a virus it is irrelevant. Just glance at what people in the grocery stores are buying. Mountains of soft drink and beer, cakes and cookies, chips chips chips, and .. when did beer become a rite of passage? Teens and college students gorge on it.
There is a real elephant in the room, no need to look for an ant.

Like this comment
Posted by James Hoosac
a resident of another community
on Sep 20, 2010 at 6:10 pm

One of the biggest problem is sugar and high fructose corn syrup. Just a can of Coke has 39g of sugar. A box of cereal often has 20% or more of its weight as sugar.

Ironically sugar is a highly subsidized industry. Our government, and the governments around the world, use tax dollars to ensure sugar prices are low. See this link:

Web Link

Maybe it is high time we turn it over. Instead of subsidizing sugar, we should tax food-grade sugar, similar to Alcohol. Higher sugar price means lower sugar consumption and healthier foods.

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Posted by James Hoosac
a resident of another community
on Sep 20, 2010 at 6:57 pm

In 1970, on average a person consumed 72.5lb of cane sugar, 7.7lb of glucose, and a small amount of other sugar sources. Total caloric sugar is 84.8 lb.

In 2008, the numbers are: 46.7 lb of can sugar, 37.8 lb of high fructose corn sweetener, 9.5 lb of glucose, with a total of 49.3 lb of corn sweeteners, and a small amount of other sugar sources. Total caloric sugar consumption is 97 lb, 15% more than 1970.

Notice that we consume much less cane sugar today than 1970. But high fructose corn sweetener consumption was virtually zero in 1970, and now stands at 37.8 lb a year. Is that the culprit? After all this is the stuff in soda cans.

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Posted by Vianica
a resident of Palo Verde School
on Sep 20, 2010 at 7:31 pm

If virus is indeed a culprit in childhood obesity, it will only be an excuse to condone bad, "costco size" eating habits and an inactive life style. And of course drug companies will make a ton of profit by promoting yet more prescription drugs to our kids. Someone here said aptly that there is something fundamentally wrong with our life style if our kids cannot go out and play without us having to arrange play dates for them or worrying about the "stranger".

Like this comment
Posted by sara is right on snacking
a resident of Leland Manor/Garland Drive
on Sep 20, 2010 at 10:47 pm

I agree with Sara and others on the dangers of snacking, especially training our children to eat snacks from the earliest age, as they are in preschools and schools here.

I am from France where snacking is considered a no-no. The saying there goes: "No eating between meals". This summer, on French television, there were public service announcements on television about obesity and excess weight gain in general. as well as adequate nutrition. They were actually aired at the same time as ads for food products ! In them they insisted it is not healthy to snack between meals.

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Posted by Wife of M.D.
a resident of Palo Alto High School
on Sep 20, 2010 at 11:53 pm

My husband says it's all about the ins and the outs. Eat too much without burning it off, and one will gain weight. But to burn it off is not as easy as our leisurely days of the past where we would skateboard, bike, or walk all over town and had time to hang out with friends after school, instead of going home and snacking as many kids do today because they have homework to start or an extracurricular to attend.

Sure, there are some medical conditions or medicines which can lead to weight gain, but not common.

Unfortunately, if one is raised on unhealthy food, it's not easy to change. That full-gut feeling one gets from fried foods is just not easy to forego for some. Just as I cannot leave the table without eating some meat (I could never be a vegetarian).

There are many times where I have been to morning meetings where food is offered, or evening meetings where dessert is offered. And all those sports events where kids are accustomed to a snack afterward? Society has gone nuts with the snacking. People are eating for emotional reasons these days. Perhaps because life is no longer as simple as it was in the past.

Parenting techniques which always make me wince: "Eat everything on your plate or no dessert for you," (i.e. eat it all even if you are no longer hungry and you can have a fat and sugar-laden award), "If you are good, you can have a piece of candy" (i.e. candy is a reward to be desired).

One more note, which is that some parents go overboard with the healthy foods. Carrot sticks and pretzels for class parties? Please, let kids have some fun. Feed your kids those but don't ruin the fun for everyone. If your child eats healthy, some junk food at a class party will not turn him into a junk food addict.

Like this comment
Posted by Wife of M.D.
a resident of Palo Alto High School
on Sep 20, 2010 at 11:56 pm

Scott Carlson wrote a funny article back in 2009: Web Link

Here's an abbreviated version:

Guest Opinion: Slay the 100-headed Snack Monster

Brace yourselves, parents, for the rearing up of the great Palo Alto Recreational-Educational Snack Complex, a monster that's relatively dormant over the summer and then raises its ravenous 100 heads in the fall.

If you've got kids over 4 years old, you've surely been tagged for a "snack." For the 10 kids on the soccer team, or the 20 on the junior varsity, or the 35 in advisory, or the 50 in pep band, or even the 100 in Paly High's freshman TEAM program. (Note to TEAM teachers: "Snack" for 100 kids is not snack — that's catering.)

Your kid's 5 years old? You're looking ahead at 10 or more years of snack duty.

What's the harm, you ask, with a little snack? Probably nothing, if it's less frequent, healthier and "greener" than how it's often done.

But one of the dark underbellies of the local snack culture is its pervasiveness, representing an out-of-whack reward system. Kids now expect a snack at any and every event they attend.

And we, the parents, are the snack machines.

In Palo Alto it seems we can't let our kids go without their reward even for...attending advisory in high school? Maybe the school board should hire Kara's to give out cupcakes at the door to Paly every morning, for showing up.

There's apparently no thought that some things are rewards in themselves: "But Dad, I just ran a healthy 45 minutes and did something good for my body and soul! Now where's my doughnut?"

More than once, I've had otherwise perfectly polite kids come up to me after an event and say only, without a trace of anything other than just dessert: "Snack?"

Yes, there may be social "functions" to the after-game snack, the bonding of team and the communal breaking of bread. But if it's done every time it becomes gratuitous (and sometimes appetite spoiling).

To restore some social significance, some "specialness," why not have a "snack" at the beginning of the season, the middle, and the end? (As hors d'oeuvres, of course, before the end-of-season dinner, party.)

So what's the snack-conscripted parent to do? I modestly propose: start a conversation, go healthy, and go green. When the subject of snack comes up for the team or event, ask other parents: Do we — meaning the kids — really need a snack? And how often?

Maybe there are times when a snack doesn't make sense because it butts up against a mealtime? If there must be a snack (and, alas, it's usually must) see if parents can generally agree on it being healthy — light on the donuts, chips, cookies or cupcakes.

And when it's your turn, think of ways to minimize packaging waste. For example, fruit juice concentrate can be mixed in your own plastic pitcher and poured into paper cups. Encourage good old water in personal water bottles. A bowl of fruit and some whole wheat bagels can be healthy and "green."

OK, I can hear it now: Call me the Snack Grinch. Stone me with your AYSO halftime orange slices (now apparently mandatory), your post-event juice pouches and boxes, your Krispy Kremes and slabs of pizza.

But like the "Whos" in Whoville, let's see if without them you can happily play soccer, put on a play or attend advisory.

Like this comment
Posted by say NO to HFCS
a resident of another community
on Sep 22, 2010 at 9:16 am

Yes, HFCS (high fructose corn syrup) is a huge problem, more so in the US than anywhere else, due to the economics involved. The government spends a fortune subsidizing the production of this poison when they should actually be taxing it instead. If you run the numbers, you could see that reversing from subsidizing to taxing could result in many BILLIONS of dollars of additional money for the government. Spend that money on improving our horrible "health care" system, combined with the lesser need for healthcare resulting from improved diet, and it seems to me to be a no-brainer that anyone but the corn farmers and unhealthy snack addicts would be in favor of this.

Like this comment
Posted by Nutrition Professional
a resident of Greenmeadow
on Sep 22, 2010 at 9:25 am

Snacking is almost never the problem, in and of itself. The quality of food (and drinks) is usually more important than the quantity (except for a minority of people with very little self-control, which may of course be a bigger issue). The real problem is when "snacks" consist of potato chips & a soda, processed crackers and "fruit drink" that is mostly artificial sugar, a "breakfast bar," etc. Give kids nuts, carrot sticks, fruit and other healthy snacks and rarely is there a least caused by the snacking. Of course make sure the drinks are healthy, too. Often people seem to think that eating fairly healthy food gives them the right to consume the most unhealthy of drinks. And of course do the same for actual meals as for snacks; keep things limited to healthy foods and drinks. And if you have dessert, keep that healthy as well. And don't eat right before going to bed. And get plenty of exercise. Good luck.

Like this comment
Posted by Moira
a resident of Midtown
on Sep 22, 2010 at 3:57 pm

Yes do eat healthy foods and limit junk foods to once and awhile. But it's also how many calories you eat and how much energy you expend, not really a new concept that needs studying. When you add more junk food to kids' diets combined with being indoors and not exercising, you have overweight kids. I grew up in a flat suburb like Palo Alto over 35 years ago. We rode our bikes everywhere or walked in groups to parks to run around, play tennis, the movies, etc. We ate after school, but not sodas and chips, most houses didn't have that stuff around except for birthday parties. We also had PE every day through 12th grade. The parents who don't let their kids bike or walk around because of unwarranted fear of kidnapping are illogical. Kidnappers don't take kids from a group off the street. Look at statistics, it's not worth keeping your kids from playing outside due to your fears. What's the point of living in a beautiful town full of parks that look largely empty of kids (except toddlers with parents/nannies).

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