Nearly 1 in 5 Children are Obese

… And Healthy Howard County is No Exception

Childhood Obesity Over Time

Childhood Obesity Over Time

On Monday morning in the Howard County Pediatric emergency room, my first patient is a 15 year old girl with high blood pressure who  has pain in her knees when she walks; she weighs 230 pounds. The next patient is a 10 year old boy who weighs 180 pounds having an asthma attack.  A little later I see a 13 year old boy who weighs over 260 pounds: he has skipped 40 days of school this year and refuses to go today because he is being picked on.

These are all nice children who live in Howard County, they have caring and concerned parents, but they are obese. Before I can ponder this too much, the nurse asks me to see an 8 year old girl who weighs 175 pounds with an MRSA infection. When I enter the room the mother has a crumpled Twinkie wrapper, and an empty bag of Doritos in her lap; she uses the half eaten Snickers bar in her hand as a pointer and asks me if they will be finished in time for lunch. The girl is on the exam table and next to her are two empty candy wrappers and her hands are clutching a bag of chips.

These patients are all being seen in Howard County General Hospital’s pediatric emergency room, not an obesity clinic. Some of these children are already having complications from their obesity. The girl with the knee pain tells me she has been walking 2 to 3 miles a day to lose weight.  The 13 year old boy says that he has attempted dieting for years and is finished going on diets.  The parents of the 10 year old  have “tried and tried” but are now waiting for him to “grow into his weight.”

These patients all tell me how difficult it is to get their weight under control. It is hard partly because exercise, while a great start, won’t do the job all by itself. For example the 15 year old will barely burn off one Snickers bar for every 40 minutes of walking. The 8 year old has an even more difficult task; she would have to a run a 10-K every day just to burn the calories from her morning snack (neither the 10-K nor the snack are recommended). In addition, as the children said, diets are tough to stick to. The easily available foods are loaded with calories and because they have very few nutrients like vitamins and minerals, they don’t really satisfy our bodies needs… so we end up eating more of them and getting way more calories than we need. We store these extra calories as fat.

To put this calorie/nutrition imbalance in perspective: a child could eat 2 bags of Doritos, a Snickers bar, an extra large soda and a helping of French fries and still not get the vitamins she would obtain from a single banana. Sadly, obtaining all that junk food can be easier than getting one piece of fruit.  The junk food would add 30 extra pounds a year to the child’s waist line, and as one of the parents commented, she would still be hungry.

While there is no easy fix, the recent guidelines issued by the Institute of Medicine try to make healthy choices part of our everyday lifestyle. The guidelines are:

  • Integrate physical activity every day in every way
  • Market what matters for a healthy life
  • Make healthy foods and beverages available everywhere
  • Activate employers and health care professionals
  • Strengthen schools as the heart of health

We need to start now or our children are going to grow up obese with serious medical problems.


David Monroe, M.D., is an Assistant Professor of Pediatrics at Johns Hopkins University and has served as the Director of the Children’s Care Center at Howard County General Hospital since 1996. He has been a member of the National Health Services Corps, providing pediatric care to underserved children, and a member of the executive committee of PECARN, a national pediatric emergency care research network. He has lived in Columbia for more than 20 years and enjoys the challenges and rewards of caring for children.



Is Your Child Overweight? Body mass index (BMI) uses height and weight measurements to estimate how much body fat a person has. To calculate BMI, use the CDC BMI calculator for children and teens. Once you know your child’s BMI, it can be plotted on a standard BMI chart. Kids fall into one of four categories: underweight:

    • BMI below the 5th percentile normal weight
    • BMI at the 5th and less than the 85th percentile overweight
    • BMI at the 85th and below 95th percentiles obese
    • BMI at or above 95th percentile

BMI is not a perfect measure of body fat and can be misleading in some situations. For example, a muscular person may have a high BMI without being overweight (because extra muscle adds to a body weight — but not fatness). In addition, BMI may be difficult to interpret during puberty when kids are experiencing periods of rapid growth. It’s important to remember that BMI is usually a good indicator — but is not a direct measurement — of body fat. If you’re worried that your child or teen may be overweight, make an appointment with your doctor, who can assess eating and activity habits and make suggestions on how to make positive changes. The doctor may also decide to screen for some of the medical conditions that can be associated with obesity.


  1. children bible stories

    I believe the answer to turning this pediatric obesity crisis around starts with the parent/guardian. Children eat what the grown ups in the house eat. What chance does the obese child have if the grown up in the house doesn’t set the example of good food choices. If a child is overweight and so are the parents/guardians, the whole family would need to change their way of eating in order for the child to be successful at weight loss.

  2. Darliene Howell

    I would like to recommend the free NAAFA Child Advocacy ToolkitSM (CATK) and other written guidelines/resources to assist you looking at programs. The total health of our nation’s children is a serious responsibility.

    The NAAFA Child Advocacy Toolkit shows how Health At Every Size® takes the focus off weight and directs it to healthful eating and enjoyable movement. It addresses the bullying, building positive self-image and eliminating stigmatization of large children. Additionally, the CATK lists resources available to parents and educators or caregivers for educational materials, curriculum and programming that is beneficial for all children. It can be found at:

    It is my hope that you will take this opportunity to look at the information held in the CATK and keep what is included in mind when making decisions regarding the children in your charge.

  3. Parent's fault

    It’s the parent’s fault, plain and simple. Where does the child get the money for the candy bar, chips, etc? That’s right, the parents. It is the parent’s job to provide the structure to give children a fighting chance in life. If they can’t (and I write this acknowledging the extreme action advocated) then the kids need to be removed from the environment. If they are not, then the kids will become yet another lost generation.

  4. Parents Fault II

    I totally agree! This issue starts @ home. Children who are malnourished are removed from the home & it’s considered abuse. Over feeding or irresponsible feeding causing obesity is just as much abuse.

  5. Parents Fault II

    Also, how sad is it, that one of the recommendations is to “strengthen schools as the heart of health.” Schools are for academics, not to do the parents job & teach the kids about proper eating! Yes, schools should serve decent food, minimally processed. But, if we continue to implement programs in school to compensate for a lack of parenting, soon there will be no room for the basics. So frustrating!

  6. schools do have a role

    The schools absolutely have a role in this fight. Health classes are already in place and are required. Movies including Weight of the Nation are good tools that could be shown in health classrooms. Cafeteria food could absolutely be healthier and vending machines that sell candy bars and sodas could be eliminated from the schools. After school snack stands and concession stands could offer healthier choices and be less about fund raising. Schools that offer rewards like ice cream sundaes for honor roll status or turn off the tv week are also missing an opportunity to teach children about intrinsic rewards- or at least healthy extrinsic rewards. Obviously- from these stories- you can’t rely solely on parents to help make the change.

  7. Did you know you had a BMI? Body mass index is a calculation that utilizes your height and weight to estimate how much body fat you’ve. Too much body fat is a problem since it may cause illnesses and other health issues.


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