Mr. Wang brings his son, a first-year junior high school student, to Tri-Service General Hospital to find out what is making the boy so fat. A man of average weight himself, Mr. Wang wonders out loud: "I'm not fat, and neither is my wife. The boy's older brother in high school weighs less than 50 kilos (110 pounds). So why is junior here already up to 70 kilos?" Mr. Wang reports that he first started noticing his son's weight six years ago, when he saw that junior was fatter than his first-grade classmates. After entering junior high school, he continued growing rounder without getting much taller. Mr. Wang once asked an endocrinologist whether his son should be treated with growth hormones, but the doctor said that junior's height fell within the normal range and that it would be better to let nature take its course. The doctor speculated that junior's problem might be an unbalanced diet, for the boy "loves to eat junk food, and has to be forced to eat vegetables."

At Tri-Service General Hospital, junior was examined by Dr. Chu Nien-feng, who found that the boy had enlarged male breasts and an underdeveloped penis. Careful testing revealed that junior's problems were perhaps caused by a hormone imbalance. But whatever the reason, he was undoubtedly obese. Obese children are more likely than others to have high blood fats, high blood sugar, and degenerative arthritis, but treatment with drugs is usually deemed inappropriate because the patients are still growing; doctors instead just aim to maintain current weight and prevent the obesity from triggering other complications.

TV and computers do harm

Parents and government authorities everywhere are growing increasingly concerned about childhood obesity. In the United States, one child in four is obese; among adults, the ratio there rises to one in three.

With the growing number of fat children in Taiwan, all the major hospitals here have begun offering consultation services on weight reduction. Tri-Service General Hospital established a children's weight loss program last summer intending to admit a maximum of 30 participants, but in the end they enrolled 35. The heaviest child tipped the scales at 102 kilos.

In 1994 Chu Nien-feng surveyed the incidence of obesity in junior high school students in Taipei City. He found that since 1980, the it had risen from 12% to 16% among boys, and from 10% to 11% among girls.

Why is the number of fat children climbing so rapidly? Dr. Chu believes the factors are complex and diverse. Overeating, lack of exercise, an excessively Westernized diet, and heredity might all play a role in any given case.

According to Dr. Chu, a Harvard study found a positive correlation between childhood obesity and time spent watching TV. Many children munch on snacks while watching TV or playing on the computer. Sitting still for hours on end, they take in too many high-fat, high-calorie foods without even realizing it. And in today's highly mechanized society, people sit in cars instead of walking, and stand in elevators instead of climbing stairs. With fewer opportunities to burn off excess energy, children naturally store up more calories than before.

Last October the Taipei Medical University surveyed all fifth- and sixth-grade students with a body mass index (BMI) of 25 or higher at three elementary schools in Taipei County and Taipei City. From over 1,000 students, researchers chose 164 obese children to test liver function and measure uric acid, blood sugar, cholesterol, and triglyceride levels. The study showed that 65% of the children had an abnormal reading in at least one of the above categories, including 45% with an abnormal uric acid level. Left unchecked, high levels of uric acid can lead to gout, and triglycerides to fatty liver.

Fortunately, many parents today understand that obesity is a warning sign of future health problems. The Taipei City Health Department polled parents to find out their views concerning the department's plan to introduce healthy boxed lunches in grades 1 through 9. The poll showed that 88% of the informants believed that obesity was an increasingly serious problem, and a quarter of the parents felt that their own children were heavier than the average. More than half weren't sure whether their children's school lunches were too high in fat and calories. And 97% of the respondents indicated support for the Health Department's plan for healthy boxed lunches.

Losing weight is more difficult for children than for adults. The younger the child, the less likely he or she is to care about weight or understand that eating high-calorie foods can cause obesity. And because they are still growing, they cannot short themselves on nutrition, thus they don't have the option, as adults do, of starving themselves to lose weight. The younger the child, the more parental supervision is required.

A health team from Tri-Service General Hospital, located in Taipei's Neihu District, visited nearby Hsinhu Elementary School to teach students about calorie intake. The team let students know, for example, how many calories there are in a cup of Coke. The team also suggested that teachers should make students go out and play on the playground during their ten-minute breaks, and also called for teachers to have students exercise for a half hour after the end of the last class of the day.

No short-cuts to weight loss

On the day before national Children's Day, Taipei Wanfang Hospital held a "Children's Health Check-up Fair" in which different types of foods were assigned different colored "traffic lights" to indicate their relative calorie content. By making it into a game, children had fun while learning about healthy eating.

According to Chin Mei-yun, director of the hospital's office of nutrition, it is not good for developing children to go hungry in an effort to lose weight. The only thing they can do is control their weight by eating the proper foods. The hospital invented a game to teach children how to identify healthy snacks. Low-nutrition, high-calorie goodies such as cakes, chocolates, potato chips, and french fries are assigned a red light, indicating that they should not be eaten too often. Hamburgers, fried chicken, and milk shakes are basically healthy, but are high in fat content and are thus assigned a yellow light, indicating that children should eat these foods in moderation. Children are encouraged to eat healthy "green-light" snacks often. This group includes such foods as boiled eggs, fresh milk, fruit, steamed buns, and sandwiches.

Says Dr. Chu: "In the past, parents thought that when children got hungry, they should just be allowed to eat, but today's parents need to think about what children should eat when they're hungry." Chu adds that many parents enroll their children in hospital weight loss programs during summer vacation, and even though the programs are very professionally run, the results don't last. Once the programs come to an end, children quickly become fat again. Parents need to pay close attention to their children's eating habits to make sure they stick as much as possible to low-calorie foods prepared with methods that make sparing use of cooking oil. Good methods include steaming, boiling, blanching, baking, and simmering. And it is advisable to serve a lot of fruits and vegetables at dinner.

There are no short-cuts to weight loss. The key is to help children limit their eating and get more exercise.

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There are more and more overweight kids these days, and parents are getting worried. Many hospitals hold weight loss clinics during summer vacations to help kids slim down.

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The Taipei city government launched a pilot lunch program on April 4, providing hot, nutritionally balanced meals at a dozen or more local schools.