MIDDLEBURY — The epidemic of childhood obesity has become something we cannot ignore. An estimated 25 to 30 percent of Vermont’s children are overweight or obese, according to a study conducted by the Centers for Disease Control and Prevention in 2011. These children are twice as likely to remain obese as adults as median-weight children are to become obese.
To local pediatrician Dr. Francisco Corbalan, these are very disturbing figures.
“We are watching the creep of obesity in our culture inch its way down to the younger people and it’s having a profoundly negative affect on their lives,” Dr. Corbalan told the Independent in a recent interview.
“We’re getting pretty close to a public health crisis.”
Porter Pediatric Primary Care in Middlebury, where Dr. Corbalan practices, sees patients from birth to age 22. As a result, Dr. Corbalan and his fellow health care professionals can get to know their patients and their patients’ families quite well and have the unique opportunity to follow changes and development of a person over time.
Dr. Corbalan says he has watched a few things unfold over recent years that combine to exacerbate the problem.
First, kids are adopting a more sedentary lifestyle. Games and social habits are less active and therefore kids are not burning the calories they need to in order to keep up with eating habits.
Then, food is becoming more caloric, “and not in a good way,” Dr. Corbalan says. In other words, calories are coming from simple sugars and fats, rather than from complex nutrients that are healthy for your body and support healthy growth.
As a result, more and more kids are creeping up into the overweight and obese ranges within the growth charts. And they’re starting to develop some very serious long-term health problems as a result.
Children as early as elementary school are developing Type 2 diabetes, hypertension, high cholesterol and high blood pressure, stroke and early signs of cardiac disease. That’s not to mention low self-esteem, depression and other debilitating mental and psychological disorders.
These are health concerns that could plague them for the rest of their lives and should be largely preventable early in life.
Dr. Corbalan and other pediatricians face the difficult and somewhat fragile task of motivating changes in behavior that can prevent or reverse these damaging diagnoses.
“Turning back and reversing is harder work than preventing this from happening at the beginning,” Dr. Corbalan says, which is part of the reason why he has decided to take a strong stand in the face of this issue.
In a recent letter to the editor published earlier this month in the Addison Independent, Dr. Corbalan says, “As a general pediatrician, I spend a lot of time discussing nutrition with my patients and their families. With the rates of obesity and other chronic diseases linked to poor nutrition continuing to cause a significant burden on people’s quality of life and on our healthcare system as a whole, continued efforts are needed to help combat this ever-growing problem.”
A STEP IN THE RIGHT DIRECTION
Dr. Corbalan goes on to support a bill that was introduced to the Vermont Senate last year, Bill S.70, that would “require restaurants licensed by the Department of Health to serve only children’s meals that meet certain requirements.”
The aim of the bill is to adjust the default options for children’s menus so that unaltered children’s meals are properly balanced with recommended quantities of vegetables, proteins, grains, fats, sugars and other nutritional components. Attention would be given to the total number of calories in the meal, limiting the amounts of sodium, sugars, and fats while defaulting to vegetables, fruits, whole grains and lean protein.
Addison County State Sen. Claire Ayer says that while the bill has not been taken up yet in the senate, she has already heard some feedback on it.
“A number of folks in the Legislature and in Vermont have let me know that they find the idea of government telling them how to feed their children offensive,” she said.
Ayer says she has sympathy for that, but on the flip side, she understands the good that could come out of the bill, too.
“The intent is to make the children’s menu default choices healthy ones,” said Ayer, a registered nurse. “American families eat food prepared outside the home far more often than ever, and childhood obesity is epidemic.”
The bill would not eliminate fries, ice cream or soda as options that kids could order out. It would simply require an intentional choice to swap out milk or water for a soda, or a side of veggies for potato chips.
According to Dr. Corbalan, that might seem like a lot of work for something that folks will just slip around.  But, he says, you might be surprised by how powerful the default choice is.
“Time and time again, the default option is the most popular,” he says. “So all we’re really trying to do here is to make that default the healthier choice.”
According to S.70, American children eat almost 20 percent of their total calories from eating out, and when they do, they consume almost twice as many calories per meal as they do when at home. 
Unfortunately, restaurants do not always provide a healthy option. A study of the 18 most profitable fast food restaurants in the United States found that only 3 percent of the 3,494 meal combinations assessed met expert nutritional standards for healthy children’s meals.
In addition to the support of pediatricians like Dr. Corbalan, S.70 has support from the American Heart Association, which has a kind of toolkit for restaurants about how to build healthy meals for children. Several local restaurant owners have also voiced support, too.
RESTAURANT PERSPECTIVE
Paris Rinder-Goddard, owner of Fire & Ice restaurant in Middlebury, updated his children’s menu back in July with similar goals in mind. The Fire & Ice children’s menu now features two sections, one for “Healthier Options” and one for “All the Favorites.” The latter list still offers cheeseburgers, grilled cheese, mozzarella sticks and the like, but the healthier options section includes grilled chicken breast and grilled salmon. Sides for kids’ meals now include apple slices, vegetable du jour and long grain wild ride.
“I am proud to offer healthier options and it feels great when parents flag me down to tell me how much they appreciate the healthier options for kids,” Rinder-Goddard says.
At the same time, Rinder-Goddard says his feelings are mixed about the specific S.70 legislation around menu options and what could or could not be marketed as options on a kids’ menu.
“All of our kid’s meals come with the salad bar, milk and cheese,” Rinder-Goddard says, “which means kids are starting out their meals at the salad bar. From there, we do let parents choose what’s a good meal option for their kids.”
As a business owner, Rinder-Goddard says he is always concerned about the overall customer experience and perceived value of his restaurant.
“If a family has a great time dining out, they’re far more likely to recommend us to others and to come back time and again,” he says. “If a parent spends their dinner fighting with their kid about eating their vegetables, then they may not have as good of a time, and the tables around them may not either.”
That family may leave not feeling happy about coming to dinner with their children and may not make the choice as readily again. It stops feeling like a treat to go out to dinner as a family. For Rinder-Goddard, and likely for any restaurant owner, that would be concerning.
Dr. Corbalan appreciates that most part parents — and most members of society — want to do the right thing for the health of children.
“This can be a sensitive conversation that we always approach with care,” he says. “For us as pediatricians this is not just a matter of how much you weigh. It’s a matter of healthy lifestyles not measured at one point in time, but a long pattern that we watch and monitor, looking for small changes we can make to improve overall lifestyle habits.”
Dr. Corbalan also said that he feels especially lucky as a pediatrician because while his primary focus is on the children, he also by default gets to treat the whole family. “Because we’re talking about nutrition and healthy habits, talking to parents about how to inspire healthy choices for their kids by chance also has a positive effect on them,” he says.
So, will changing the default option on a restaurant children’s menu in Vermont solve the overwhelming epidemic of obesity in our culture? Probably not. But might it spark a conversation about nutrition with your pediatrician or inspire families to shift their choices and even preferences toward more nutritious alternatives, starting a cascade of healthier choices for their lives? Just maybe.