Chat transcript: Dr. John Monaco on childhood obesity

(CNN) -- Dr. John Monaco, author of "Slim and Fit Kids: Raising Healthy Children in a Fast-Food World"(Health Communications Inc.) joined CNN.com on October 15, 1999, to chat about what you can do to help your children combat obesity. Peeke joined us from Tampa, Florida, and CNN.com provided a typist. The following is an edited transcript of the chat.

Chat Moderator: Welcome, Dr. John Monaco!

Dr. Monaco: Hello. Thank you for inviting me.

Chat Moderator: What inspired you to create this book?

Dr. Monaco: I am an intensive care pediatrician and have noticed the dramatically increased frequency and severity of childhood obesity. I've realized that this is a health concern of children today and not something that we can wait too long to correct. I'm also a parent of two school-age children. And I was a fat kid myself. All of those issues together brought this problem to the forefront of my thoughts.

Question from Laureen: Is there a relationship between obesity in a child and in his parents?

Dr. Monaco: Hi Laureen. There's no doubt that there is a genetic connection between body types in parents and children. However, probably much more important than that is that children tend to eat the same foods and in the same manner as their parents.

Chat Moderator: Does increased body fat really cause earlier puberty?

Dr. Monaco: Yes, we believe so. The reason for that is that the ovaries, particularly, sense the degree of body fat to know when they should turn on. We really believe that one of the contributors to the teen-age pregnancy problem is the fact that girls and boys are achieving puberty sooner and therefore able to become pregnant sooner.

Chat Moderator: Is there anything wrong with having a chunky child?

Dr. Monaco: In and of itself, no. The problem is if the child has some underlying medical condition, like asthma for example, it can make the asthma more of a problem. But the real problem for overweight kids is the psychological impact it has on them. Despite the fact that there are more overweight kids today, they still, in many circumstances, feel ostracized from their peers. So, although there's nothing particularly wrong per se, if it has a negative impact on their life, then it's something we need to do something about.

Question from Veggievet: Can a child eat a balanced vegetarian diet?

Dr. Monaco: Actually, that's a great question. Although we don't feel that meats are a bad thing, we do feel that protein, particularly animal protein, is over emphasized in our culture and perhaps we hear far more of it than we actually need. That combined with our concerns with the use of pesticides, hormones, fertilizers and other chemicals in growing and procuring meats, has caused our recommendations to emphasize carbohydrates and plant proteins, like soy. So, to answer your question, we truly believe that a child can eat a healthy vegetarian diet and it may actually be of some benefit and prevent obesity in many cases.

Question from Tecie: What if my child is not considered overweight now, but borderline. I see her start gaining growth in height -- is there a way to predict her size?

Dr. Monaco: Traditionally, pediatricians have used growth curves to plot child growth and development. The assumption is that if, for example, your child is in the 60th percentile for height, that you can predict where he will be in several years down the road. There are two problems with this however, one is that children that are overweight tend also to be taller. Therefore, somewhat confusing the growth curve and the predictions about height.

Dr. Monaco: Secondly, because kids have gotten so much bigger, the growth curve data, which is about 20 years old, no longer represents where the population is today. So the answer is that is it difficult to predict, but if your child is prepubescent she will still grow until she reaches puberty.

Chat Moderator: Halloween is coming up. How should a parent handle that big orange plastic pumpkin full of candy. Should you let them eat at will or only let them have a piece or two a day?

Dr. Monaco: That is a great question. Because both of your options are good for different reasons. By letting them have whatever they want, your not using food as either a punishment or a reward which is sometimes one of the issues in overweight children. But, of course, you are overloading their digestive system with large volumes of refined sugars. So it is probably not the healthiest option. The second option is probably the healthier way to approach the problem, but whenever you create the perception that candy is some ultimate reward for good behavior, for example, then you cause children to want candy even more. So, the answer is to (knowing that you know your child better than anyone) use common sense and know that Halloween only happens once a year.

Question from Haley: Dr. Monaco, do you believe in the theory that if baby is fed solids too early in life the child is predisposed to having an obesity problem?

Dr. Monaco: Actually, I do. There was a recent study in Europe that found that babies that remained on breast milk alone the longest, compared with others that were on breast milk alone for only a short time. The ones who stayed on the longest had the lowest incidence of childhood obesity. During the first year of life children really only require either breast milk or formula as a well balanced nutritional source. Not that they should not have solids, but you really shouldn't feel rushed to introduce them early.

Question from Mags: Why are so many kids overweight?

Dr. Monaco: The answer to that question has to do with what has evolved in our culture in the last 20-30 years. It is during that time interval that the problem has really exploded. In essence, we have become a culture that values convenience over solid nutrition. So, we are eating more and more foods that are not real food. In other words, laced with chemicals, preservatives and non-nutritional elements. And although it is true that kids do spend a lot of time in front of the television, computer and video games, there is also a lot more opportunity for organized sporting activities than ever before. But what kids don't do that they did 20-30 years ago, is participate in random play like bike riding, playing tag, and running around the neighborhood without a true structure. So, really it's our busy lives that have a lot to do with the problem. Plus, I really think that we are forcing kids to grow up faster than they really need to. So they eat food for many more reasons other than just hunger or nutrition, just like we adults do. Food has also become a comfort measure for many children.

Question from Veggievet: Have you found any correlation between obesity and children adopted out of an international orphanage?

Dr. Monaco: I haven't had specific experience with that particular issue, but I do know that in the far-east, now that it is becoming Americanized like the rest of the world, they are having to deal with a tremendous increase in overweight children that they had not experienced before. So I think that the environment that you place a child in is critically important to their nutrition.

Chat Moderator What's the WRONG way to encourage a child to lose weight?

Dr. Monaco: The wrong way is to make them feel even worse about themselves than they already feel. In other words, the emphasis needs to be on the positive. It is important to encourage a child to eat healthy which will have the end result of slimming them down. As opposed to taking the negative approach and saying that they need to correct some problem that they have in their eating. Also, because we should not under estimate the intensity of the self-esteem issues attached to being an overweight child. It is important to emphasize what that child feels good about themselves about. For example, if your child is a grade student, then that need to be reinforced. If your child has a warm and giving personality then that needs to be reinforced. So whatever you do, don't make your child feel even more left out than they already do.

Chat Moderator: What kinds of exercise do you recommend for children? Are there some that kids take to more readily?

Dr. Monaco: Yes. We have worked with two exercise specialists who have formulated programs of non-competitive, non-achievement oriented, movement exercises. These are designed to put a child back in touch with their body, to work all their muscles, their joints, and with some aerobic exercises. The most important thing to remember is that adults exercise with a goal in mind like building strength, losing weight, etc... Children, on the other hand, just want to have fun. So they will only do things/activities that are fun and we really feel that movement exercises, some of which can be done to music and in your own living room, are a great opportunity for families to exercise together. Which is another key component to a good exercise program. Some parents may say that they are already spending half their day carting children to soccer, little league, and dance classes. But it may be that we need to spend a little less time on those structured activities and more time on having fun together as families.

Question from Veggievet: Would you recommend organically grown produce and does that depend on the type of produce and the age of the child.

Dr. Monaco: In general, a very strong recommendation of our program is that if it is possible for you, you should eat as much organic food as possible. There really is no age limitation on that. In fact, for infants and toddlers, vegetables and fruits you puree yourself that you know are fresh and not containing chemicals are preferable over processed "baby foods".

Question from Mags: It seems that if a child is overweight it's because the parents allow them to eat too much, or too much junk food...so wouldn't more parental supervision take care of the problem?

Dr. Monaco: Children learn by example. If your family eats healthy snacks and has only healthy snacks available, there's a much better chance that your child will do the same. If, however, high concentrated refined sugars and hydrogenated fats are present in most of the food in your house, then they have very little choice but to eat those foods. So you are absolutely right and one of the challenges that we in pediatrics face with virtually every childhood health issue is that we have two sets of patients -- the children, and sometimes even more challenging, the parents.

Question from Hoody: Is it ok for children to either take low fat food products and will that effect nutrition?

Dr. Monaco: The thing to remember when it comes to fat as a nutrient is that it is absolutely essential for the normal growth and development of children. Don't forget that the human nervous system undergoes a tremendous amount of development during the first few years of life. An integral part of the nervous system is fat. So, in general, we feel that no-fat and low-fat foods are inappropriate for children because in their efforts to limit the unhealthy fats they may also be limiting the essential fats.

Question hello: How about when they start going to kindergarten and watch other children eat "good food," what to do then?

Dr. Monaco: That problem is something that can be dealt with by very open communication early on in your family. I'm not saying that your child should be judgmental about the way other children eat, but you need to have conversations fairly early on that there are different ways to eat and some are healthier than others. But I do not mean to minimize that challenge. I think we need to be realistic and recognize that children are going to be exposed to all sorts of foods and eating styles and it is just another one of the challenges of teaching children to make good choices.

Chat Moderator: Any final thoughts?

Dr. Monaco: You asked excellent questions and touched on many of the issues we attempted to deal with in the book. I thank you for sharing your thoughts with me.

Chat Moderator: Thank you for joining us, Dr. John Monaco!

Dr. Monaco: Goodbye everyone. Dr. John Monaco is director of the Pediatric intensive Care Unit and Chairman of the Department of Inpatient Pediatrics at Brandon Regional Hospital in Brandon, Florida.